Provider Demographics
NPI:1871123091
Name:GOLOVIN-GREER, LAURA IRENE (BSSW, MED)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:IRENE
Last Name:GOLOVIN-GREER
Suffix:
Gender:F
Credentials:BSSW, MED
Other - Prefix:
Other - First Name:LAURA
Other - Middle Name:IRENE
Other - Last Name:GOLOVIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:860 E RIVER PL STE 100
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39202-3442
Mailing Address - Country:US
Mailing Address - Phone:769-251-5550
Mailing Address - Fax:769-251-5590
Practice Address - Street 1:3452 PASCAGOULA ST STE 3
Practice Address - Street 2:
Practice Address - City:PASCAGOULA
Practice Address - State:MS
Practice Address - Zip Code:39567-3203
Practice Address - Country:US
Practice Address - Phone:228-712-8024
Practice Address - Fax:228-712-8027
Is Sole Proprietor?:No
Enumeration Date:2020-01-16
Last Update Date:2020-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker