Provider Demographics
NPI:1710142294
Name:WARE, JOHNNIE DENISE (MS, LMFT)
Entity Type:Individual
Prefix:MS
First Name:JOHNNIE
Middle Name:DENISE
Last Name:WARE
Suffix:
Gender:F
Credentials:MS, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5818 KINGS PL
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39211-3320
Mailing Address - Country:US
Mailing Address - Phone:601-572-1257
Mailing Address - Fax:
Practice Address - Street 1:5818 KINGS PL
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39211-3320
Practice Address - Country:US
Practice Address - Phone:601-572-1257
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-23
Last Update Date:2008-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MST0211106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MST0211OtherMISSISSIPPI BOARD OF EXAMINERS FOR SOCIAL WORK & MARRIAGE AND FAMILY THERAPY