# PREMIER PROFESSIONAL COUNSELING SERVICES, LLC

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

## Provider details

- **NPI number:** 1750878781
- **Authorized official:** JOCELYN GAVIN-LANE LCSW, MPH (OWNER)
- **Authorized official phone:** (228) 220-4226

## Contact information

- **Practice address:** 1390 29TH AVE STE B, GULFPORT, MS 39501-1945
- **Practice address phone:** (228) 220-4226
- **Practice address fax:** (228) 220-4303
- **Mailing address:** PO BOX 10743, GULFPORT, MS 39505-0743
- **Mailing address phone:** (228) 220-4226

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1041C0700X | Clinical Social Worker | C6462 | MS | Yes |

## Other

- **Enumeration date:** 04/16/2018
- **Last updated:** 04/16/2018

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 05525369 | — | MS |