Healthcare Provider Details

I. General information

NPI: 1235694191
Provider Name (Legal Business Name): JOAN S WALDROUP, LCSW, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/05/2019
Last Update Date: 12/14/2025
Certification Date: 12/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1403 43RD AVE
GULFPORT MS
39501-2545
US

IV. Provider business mailing address

PO BOX 7475
GULFPORT MS
39506-7475
US

V. Phone/Fax

Practice location:
  • Phone: 228-234-9460
  • Fax: 228-241-0326
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: JOAN S WALDROUP
Title or Position: OWNER
Credential: LCSW
Phone: 228-860-0506