Provider Demographics
NPI:1598113482
Name:JOHNSON, SYRENIA (LCSW)
Entity Type:Individual
Prefix:DR
First Name:SYRENIA
Middle Name:
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:DR
Other - First Name:SYRENIA
Other - Middle Name:LESLIE
Other - Last Name:WINTERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:1330 SUNSET DR
Mailing Address - Street 2:
Mailing Address - City:GRENADA
Mailing Address - State:MS
Mailing Address - Zip Code:38901-4000
Mailing Address - Country:US
Mailing Address - Phone:662-892-2660
Mailing Address - Fax:662-892-2660
Practice Address - Street 1:1330 SUNSET DR
Practice Address - Street 2:
Practice Address - City:GRENADA
Practice Address - State:MS
Practice Address - Zip Code:38901-4000
Practice Address - Country:US
Practice Address - Phone:662-892-2660
Practice Address - Fax:662-892-2660
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-01
Last Update Date:2023-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSC94981041C0700X
TN68301041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical