| Joan S Waldroup, Lcsw, Pllc | |
|
1403 43rd Ave Gulfport MS 39501-2545 | |
| (228) 234-9460 | |
| (228) 241-0326 |
| Full Name | Joan S Waldroup, Lcsw, Pllc |
|---|---|
| Speciality | Social Worker |
| Location | 1403 43rd Ave, Gulfport, Mississippi |
| Authorized Official Name and Position | Joan S Waldroup (OWNER) |
| Authorized Official Contact | 2288600506 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Joan S Waldroup, Lcsw, Pllc Po Box 7475 Gulfport MS 39506-7475 Ph: () - | Joan S Waldroup, Lcsw, Pllc 1403 43rd Ave Gulfport MS 39501-2545 Ph: (228) 234-9460 |
| NPI Number | 1235694191 |
|---|---|
| Provider Enumeration Date | 02/05/2019 |
| Last Update Date | 03/28/2019 |
| Medicare PECOS PAC ID | 9436491800 |
|---|---|
| Medicare Enrollment ID | O20190506000292 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1235694191 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
| Provider Name | Joan T Waldroup |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1457365447 PECOS PAC ID: 6608879044 Enrollment ID: I20060824000364 |
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