Provider Demographics
NPI:1871181271
Name:COCKRELL, LORA (LCSW)
Entity Type:Individual
Prefix:
First Name:LORA
Middle Name:
Last Name:COCKRELL
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 1:20 COUNTY ROAD 289
Mailing Address - Street 2:
Mailing Address - City:ABBEVILLE
Mailing Address - State:MS
Mailing Address - Zip Code:38601-9709
Mailing Address - Country:US
Mailing Address - Phone:662-371-4406
Mailing Address - Fax:
Practice Address - Street 1:2690 W OXFORD LOOP STE 146
Practice Address - Street 2:
Practice Address - City:OXFORD
Practice Address - State:MS
Practice Address - Zip Code:38655-5575
Practice Address - Country:US
Practice Address - Phone:662-371-4406
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-02
Last Update Date:2021-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSC5982101YM0800X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health