Individual
MS. LISA K CRAIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MED,LSW,CMHT
Contact information
Practice address
1600 BROAD AVE, GULFPORT, MS 39501-3603
(228) 863-1132
(228) 865-1700
Mailing address
1600 BROAD AVE, GULFPORT, MS 39501-3603
(228) 863-1132
(228) 865-1700
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
W3612
MS
101YP2500X
Professional Counselor
Primary
W3612
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00018213
—
MS
Enumeration date
07/11/2006
Last updated
09/11/2025
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