| Organization Name: | MARY R. STOCK, PHD, LCSW, LLC |
| NPI Number: | 1629381728 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | MARY R STOCK (LICENSED CLINICAL SOCIAL WORKER) |
| Mailing Address: | 4423 Leisure Time Dr Diamondhead |
| State: | MS US |
| Postal Code: | 395253221 |
| Phone Number: | 2282160130 |
| Fax Number: | |
| NPI Enumeration Date: | 07/17/2010 |
| NPI Last Update Date: | 07/17/2010 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 1041C0700X |
| License Number: | C2936 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MS |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Social Worker |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | A social worker who holds a master |