Individual
MS. THERESA FLANAGAN FORDHAM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPC LSW
Contact information
Practice address
1636 POPPS FERRY RD STE 116, BILOXI, MS 39532
(228) 596-9903
(228) 396-5001
Mailing address
PO BOX 7884, GULFPORT, MS 39506
(228) 596-9903
(228) 396-5001
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
0934
MS
104100000X
Social Worker
W4171
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
472900000
MAGELLAN HEALTH
MS
01
—
A931421
VALUE OPTIONS
MS
Enumeration date
10/03/2006
Last updated
01/19/2017
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