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1093313660
DETRICK JOHNSON
JACKSON, MS
NPI
1093313660
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
No
Primary Taxonomy
101YM0800X Counselor, Mental Health
Enumeration Date
2020-10-15
Last Update Date
2020-10-15
Business Address
DETRICK JOHNSON
3450 HIGHWAY 80 W
JACKSON, MS 39209-7201
Phone number: 601-321-2400
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Mailing Address
DETRICK JOHNSON
3450 HIGHWAY 80 W
JACKSON, MS 39209-7201
Phone number: 601-321-2400
Copy
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