Provider Demographics
NPI:1114403912
Name:MCCOVERY, SHAQUINA (LMSW)
Entity Type:Individual
Prefix:
First Name:SHAQUINA
Middle Name:
Last Name:MCCOVERY
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13353 WILLOW OAK CIR
Mailing Address - Street 2:
Mailing Address - City:GULFPORT
Mailing Address - State:MS
Mailing Address - Zip Code:39503-5550
Mailing Address - Country:US
Mailing Address - Phone:601-731-8323
Mailing Address - Fax:
Practice Address - Street 1:1635 POPPS FERRY RD
Practice Address - Street 2:
Practice Address - City:BILOXI
Practice Address - State:MS
Practice Address - Zip Code:39532-2312
Practice Address - Country:US
Practice Address - Phone:228-207-0725
Practice Address - Fax:228-207-0735
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-14
Last Update Date:2018-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSM8388104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker