Provider Demographics
NPI:1033158936
Name:GAVIN-LANE, JOCELYN (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:JOCELYN
Middle Name:
Last Name:GAVIN-LANE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 10743
Mailing Address - Street 2:
Mailing Address - City:GULFPORT
Mailing Address - State:MS
Mailing Address - Zip Code:39505-0743
Mailing Address - Country:US
Mailing Address - Phone:228-604-0099
Mailing Address - Fax:228-604-2001
Practice Address - Street 1:10585 THREE RIVERS RD
Practice Address - Street 2:SUITE C
Practice Address - City:GULFPORT
Practice Address - State:MS
Practice Address - Zip Code:39503-3572
Practice Address - Country:US
Practice Address - Phone:228-604-0099
Practice Address - Fax:228-604-2001
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-06
Last Update Date:2013-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSC64621041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical