| Premier Professional Counseling Services, Llc | |
|
1390 29th Ave Ste B Gulfport MS 39501-1945 | |
| (228) 220-4226 | |
| (228) 220-4303 |
| Full Name | Premier Professional Counseling Services, Llc |
|---|---|
| Speciality | Social Worker |
| Location | 1390 29th Ave Ste B, Gulfport, Mississippi |
| Authorized Official Name and Position | Jocelyn Gavin-lane (OWNER) |
| Authorized Official Contact | 2282204226 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Premier Professional Counseling Services, Llc Po Box 10743 Gulfport MS 39505-0743 Ph: (228) 220-4226 | Premier Professional Counseling Services, Llc 1390 29th Ave Ste B Gulfport MS 39501-1945 Ph: (228) 220-4226 |
| NPI Number | 1750878781 |
|---|---|
| Provider Enumeration Date | 04/16/2018 |
| Last Update Date | 04/16/2018 |
| Medicare PECOS PAC ID | 7214329358 |
|---|---|
| Medicare Enrollment ID | O20220121001016 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1750878781 | NPI | - | NPPES |
| 05525369 | Medicaid | MS |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | C6462 (Mississippi) | Primary |
| Provider Name | Jocelyn Gavin-lane |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1033158936 PECOS PAC ID: 0941692081 Enrollment ID: I20220121001070 |
| Provider Name | Riva Cornelius |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1881287118 PECOS PAC ID: 3870987159 Enrollment ID: I20220302002327 |
| Provider Name | Julie M Stewart |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1871215145 PECOS PAC ID: 3072982248 Enrollment ID: I20221209001077 |
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