Provider Demographics
NPI:1497969315
Name:ELEUTERIUS, MICHELLE MARIE (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:MARIE
Last Name:ELEUTERIUS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MISS
Other - First Name:MICHELLE
Other - Middle Name:MARIE
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:708 OLD SAVANNAH DR
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:MS
Mailing Address - Zip Code:39560-9605
Mailing Address - Country:US
Mailing Address - Phone:228-863-3086
Mailing Address - Fax:
Practice Address - Street 1:127 GARY ST
Practice Address - Street 2:
Practice Address - City:GULFPORT
Practice Address - State:MS
Practice Address - Zip Code:39503-3503
Practice Address - Country:US
Practice Address - Phone:228-832-0556
Practice Address - Fax:228-831-4495
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSC57441041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical