Provider Demographics
NPI:1255073888
Name:MCCORVEY, CAROLYN LEWIS (LCSW)
Entity type:Individual
Prefix:MS
First Name:CAROLYN
Middle Name:LEWIS
Last Name:MCCORVEY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:CAROLYN
Other - Middle Name:PATRICIA
Other - Last Name:LEWIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:18620 ELKWOOD DR
Mailing Address - Street 2:
Mailing Address - City:GULFPORT
Mailing Address - State:MS
Mailing Address - Zip Code:39503-5697
Mailing Address - Country:US
Mailing Address - Phone:904-477-7398
Mailing Address - Fax:
Practice Address - Street 1:18620 ELKWOOD DR
Practice Address - Street 2:
Practice Address - City:GULFPORT
Practice Address - State:MS
Practice Address - Zip Code:39503-5697
Practice Address - Country:US
Practice Address - Phone:904-477-7398
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-13
Last Update Date:2022-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSC-45191041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical