=====================================================
General NPI Number Information
=====================================================
NPI Number | 1831961762
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | GULF COAST SOCIAL WORK LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/24/2023
-----------------------------------------------------
Last Update Date | 04/11/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4836 MAIN ST
-----------------------------------------------------
City | MOSS POINT
-----------------------------------------------------
State | MS
-----------------------------------------------------
Zip | 39563-2700
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 228-278-5109
-----------------------------------------------------
Fax | 866-364-0421
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 1703
-----------------------------------------------------
City | OCEAN SPRINGS
-----------------------------------------------------
State | MS
-----------------------------------------------------
Zip | 39566-1703
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 228-278-5109
-----------------------------------------------------
Fax | 866-364-0421
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | MRS. KAREN MELINDA ZITTLEMAN
-----------------------------------------------------
Credential | LCSW
-----------------------------------------------------
Telephone | 228-326-7575
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 104100000X
-----------------------------------------------------
Taxonomy Name | Social Worker
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------