Dr Syrenia Johnson, LCSW | |
1330 Sunset Dr, Grenada, MS 38901-4000 | |
(662) 892-2660 | |
(662) 892-2660 |
Full Name | Dr Syrenia Johnson |
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Gender | Female |
Speciality | Social Worker - Clinical |
Location | 1330 Sunset Dr, Grenada, Mississippi |
Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
Identifier | Type | State | Issuer |
---|---|---|---|
1598113482 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
1041C0700X | Social Worker - Clinical | C9498 (Mississippi) | Secondary |
1041C0700X | Social Worker - Clinical | 6830 (Tennessee) | Primary |
Entity Name | Psychosocial Boutique Pllc |
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Entity Type | Part B Supplier - Clinic/group Practice |
Entity Identifiers | NPI Number: 1841846904 PECOS PAC ID: 7517298425 Enrollment ID: O20191008000561 |
Mailing Address | Practice Location Address |
---|---|
Dr Syrenia Johnson, LCSW 1330 Sunset Dr, Grenada, MS 38901-4000 Ph: (662) 892-2660 | Dr Syrenia Johnson, LCSW 1330 Sunset Dr, Grenada, MS 38901-4000 Ph: (662) 892-2660 |
Mr. Halle Ricketts, MSW LICSW/LCSW LSSW Clinical Social Worker Medicare: Not Enrolled in Medicare Practice Location: 121 N Lynch St, Grenada, MS 38901 Phone: 601-226-0284 | |
Ms. Elizabeth Michelle Woods, LMSW Clinical Social Worker Medicare: Not Enrolled in Medicare Practice Location: 141 Sunset Loop, Agape Adult Day Services And Recreational Center, Llc, Grenada, MS 38901 Phone: 662-307-2584 Fax: 662-307-2666 | |
Mrs. Mamie Swims, LCSW Clinical Social Worker Medicare: Medicare Enrolled Practice Location: 983 S Line St, Grenada, MS 38901 Phone: 662-809-3794 Fax: 662-226-3794 |