# MARY R. STOCK, PHD, LCSW, LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1629381728
- **Authorized official:** MARY R STOCK PHD, LCSW (LICENSED CLINICAL SOCIAL WORKER)
- **Authorized official phone:** (228) 216-0130

## Contact information

- **Practice address:** 4423 LEISURE TIME DR, DIAMONDHEAD, MS 39525-3221
- **Practice address phone:** (228) 216-0130
- **Mailing address:** PO BOX 1144, KILN, MS 39556-1144
- **Mailing address phone:** (228) 216-0130

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1041C0700X | Clinical Social Worker | C2936 | MS | Yes |

## Other

- **Enumeration date:** 07/17/2010
- **Last updated:** 07/17/2010

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 1811153042 | NPI | — |