MEDICARE: DR. KIARA WILLIAMS JOHNSON DPC, LPC, NCC, NCSC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	3217	MS
2	101YS0200X	School Counselor	312666	MS
3	101YP2500X	Professional Counselor	3217	MS

General Provider Information

NPI Number	:	1902611965
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KIARA WILLIAMS JOHNSON DPC, LPC, NCC, NCSC

Provider Business Mailing Address
First Line	:	4780 I 55 N STE 116
Second Line	:
City	:	JACKSON
State	:	MS
Zip	:	39211-6067
Country	:	US
Telephone Number	:	662-214-5554
Fax Number	:

Provider Business Practice Location Address
First Line	:	4780 I 55 N STE 116
Second Line	:
City	:	JACKSON
State	:	MS
Zip	:	39211-6067
Country	:	US
Telephone Number	:	662-214-5554
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/07/2025
Last Update Date	:	12/23/2025

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