Healthcare Provider Details

I. General information

NPI: 1245156678
Provider Name (Legal Business Name): NAOMI ANN MCKNEELY LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/29/2026
Last Update Date: 06/29/2026
Certification Date: 06/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10824 CHEROKEE ROSE RD
VANCLEAVE MS
39565-9595
US

IV. Provider business mailing address

911 41ST AVE
GULFPORT MS
39501-1447
US

V. Phone/Fax

Practice location:
  • Phone: 228-283-5005
  • Fax:
Mailing address:
  • Phone: 228-234-6136
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberM11341
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: