Provider Demographics
NPI:1639616378
Name:GAUTHREAUX, GINA (LCSW)
Entity Type:Individual
Prefix:
First Name:GINA
Middle Name:
Last Name:GAUTHREAUX
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 4594
Mailing Address - Street 2:
Mailing Address - City:BILOXI
Mailing Address - State:MS
Mailing Address - Zip Code:39535-4594
Mailing Address - Country:US
Mailing Address - Phone:228-273-4096
Mailing Address - Fax:228-594-1765
Practice Address - Street 1:180 DEBUYS RD
Practice Address - Street 2:STE 203
Practice Address - City:BILOXI
Practice Address - State:MS
Practice Address - Zip Code:39531-4402
Practice Address - Country:US
Practice Address - Phone:228-273-4096
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-19
Last Update Date:2020-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSC47221041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical