Provider Demographics
NPI:1649587460
Name:GERVIN-WARD, STELLA ELIZABETH (LCSW)
Entity Type:Individual
Prefix:MS
First Name:STELLA
Middle Name:ELIZABETH
Last Name:GERVIN-WARD
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 1:4555 HIGHLAND PARK DR
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:MS
Mailing Address - Zip Code:39307-5429
Mailing Address - Country:US
Mailing Address - Phone:601-581-7775
Mailing Address - Fax:601-581-7616
Practice Address - Street 1:4555 HIGHLAND PARK DR
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:MS
Practice Address - Zip Code:39307-5429
Practice Address - Country:US
Practice Address - Phone:601-581-7775
Practice Address - Fax:601-581-7616
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-01
Last Update Date:2010-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSC27591041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical