Provider Demographics
NPI:1144380874
Name:JOHNSON, GAIL H (LCSW)
Entity type:Individual
Prefix:MRS
First Name:GAIL
Middle Name:H
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1903 PASS ROAD
Mailing Address - Street 2:SUITE E
Mailing Address - City:BILOXI
Mailing Address - State:MS
Mailing Address - Zip Code:39531
Mailing Address - Country:US
Mailing Address - Phone:228-594-9010
Mailing Address - Fax:228-594-9012
Practice Address - Street 1:1903 PASS RD
Practice Address - Street 2:SUITE E
Practice Address - City:BILOXI
Practice Address - State:MS
Practice Address - Zip Code:39531-4103
Practice Address - Country:US
Practice Address - Phone:228-594-9010
Practice Address - Fax:228-594-9012
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSC01181041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical