Provider Demographics
NPI:1508407263
Name:COCHRAN, GINA (LPC)
Entity Type:Individual
Prefix:
First Name:GINA
Middle Name:
Last Name:COCHRAN
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:GINA
Other - Middle Name:KELLY
Other - Last Name:COCHRAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1902 WILSON AVE
Mailing Address - Street 2:
Mailing Address - City:PASCAGOULA
Mailing Address - State:MS
Mailing Address - Zip Code:39567-5774
Mailing Address - Country:US
Mailing Address - Phone:228-235-6461
Mailing Address - Fax:228-471-5303
Practice Address - Street 1:1810 OLD MOBILE AVE
Practice Address - Street 2:
Practice Address - City:PASCAGOULA
Practice Address - State:MS
Practice Address - Zip Code:39567-4412
Practice Address - Country:US
Practice Address - Phone:228-712-5077
Practice Address - Fax:228-202-1741
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-03
Last Update Date:2023-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X
MS2402101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor