Provider Demographics
NPI:1205037512
Name:HINSON, JANISE A (PHD)
Entity type:Individual
Prefix:DR
First Name:JANISE
Middle Name:A
Last Name:HINSON
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4500 I-55 NORTH SUITE #208
Mailing Address - Street 2:HIGHLAND VILLAGE
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39211
Mailing Address - Country:US
Mailing Address - Phone:601-981-5757
Mailing Address - Fax:
Practice Address - Street 1:4500 I-55 NORTH SUITE #208
Practice Address - Street 2:HIGHLAND VILLAGE
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39211
Practice Address - Country:US
Practice Address - Phone:601-981-5757
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS44709103TC1900X
TX25213T103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling