Provider Demographics
NPI:1629293691
Name:GULF COAST FAMILY COUNSELING AGENCY
Entity Type:Organization
Organization Name:GULF COAST FAMILY COUNSELING AGENCY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:
Authorized Official - Last Name:TRACY-KINSEY
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:228-875-6113
Mailing Address - Street 1:PO BOX 1073
Mailing Address - Street 2:
Mailing Address - City:OCEAN SPRINGS
Mailing Address - State:MS
Mailing Address - Zip Code:39566-1073
Mailing Address - Country:US
Mailing Address - Phone:228-875-6113
Mailing Address - Fax:228-875-6113
Practice Address - Street 1:509 JACKSON AVE
Practice Address - Street 2:
Practice Address - City:OCEAN SPRINGS
Practice Address - State:MS
Practice Address - Zip Code:39564-4619
Practice Address - Country:US
Practice Address - Phone:228-875-6113
Practice Address - Fax:228-875-6113
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-16
Last Update Date:2022-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty