Organization
PREMIER PROFESSIONAL COUNSELING SERVICES, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JOCELYN GAVIN-LANE LCSW, MPH (OWNER)
(228) 220-4226
Entity
Organization
Contact information
Practice address
1390 29TH AVE STE B, GULFPORT, MS 39501-1945
(228) 220-4226
(228) 220-4303
Mailing address
PO BOX 10743, GULFPORT, MS 39505-0743
(228) 220-4226
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
C6462
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
05525369
—
MS
Enumeration date
04/16/2018
Last updated
04/16/2018
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