Provider Demographics
NPI:1740288992
Name:AYCOCK, GAIL H (LCSW,BCD)
Entity type:Individual
Prefix:MRS
First Name:GAIL
Middle Name:H
Last Name:AYCOCK
Suffix:
Gender:F
Credentials:LCSW,BCD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:911 VERRET ST
Mailing Address - Street 2:
Mailing Address - City:HOUMA
Mailing Address - State:LA
Mailing Address - Zip Code:70360-4637
Mailing Address - Country:US
Mailing Address - Phone:985-851-6237
Mailing Address - Fax:985-876-2878
Practice Address - Street 1:911 VERRET ST
Practice Address - Street 2:
Practice Address - City:HOUMA
Practice Address - State:LA
Practice Address - Zip Code:70360-4637
Practice Address - Country:US
Practice Address - Phone:985-851-6237
Practice Address - Fax:985-876-2878
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-12
Last Update Date:2011-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA18311041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA55318Medicare PIN