Provider Demographics
NPI:1578876280
Name:WEIDEMANN, JOY A (LCSW)
Entity Type:Individual
Prefix:
First Name:JOY
Middle Name:A
Last Name:WEIDEMANN
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 1:120 STREET A STE C
Mailing Address - Street 2:
Mailing Address - City:PICAYUNE
Mailing Address - State:MS
Mailing Address - Zip Code:39466-5466
Mailing Address - Country:US
Mailing Address - Phone:601-215-6087
Mailing Address - Fax:601-799-3536
Practice Address - Street 1:120 STREET A STE C
Practice Address - Street 2:
Practice Address - City:PICAYUNE
Practice Address - State:MS
Practice Address - Zip Code:39466
Practice Address - Country:US
Practice Address - Phone:601-215-6087
Practice Address - Fax:601-799-3536
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-22
Last Update Date:2018-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSM75331041C0700X
MSC75331041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical