Individual
MS. MYIA CORMICHEL LANE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
4605 GOLDFINCH DR, GULFPORT, MS 39501-7218
(228) 219-5219
Mailing address
69 HOLLY CIR, GULFPORT, MS 39501-8629
(228) 219-5219
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
M9748
MS
1041C0700X
Clinical Social Worker
Primary
C11117
MS
Other
Enumeration date
07/31/2023
Last updated
08/26/2024
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