Provider Demographics
NPI:1053810572
Name:MCCORMICK, JUAWICE (LPC, LPC-S, NCC, DCC)
Entity type:Individual
Prefix:DR
First Name:JUAWICE
Middle Name:
Last Name:MCCORMICK
Suffix:
Gender:F
Credentials:LPC, LPC-S, NCC, DCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1918 FULLER ST
Mailing Address - Street 2:
Mailing Address - City:HATTIESBURG
Mailing Address - State:MS
Mailing Address - Zip Code:39401-7544
Mailing Address - Country:US
Mailing Address - Phone:662-617-4626
Mailing Address - Fax:
Practice Address - Street 1:1918 FULLER ST
Practice Address - Street 2:
Practice Address - City:HATTIESBURG
Practice Address - State:MS
Practice Address - Zip Code:39401-7544
Practice Address - Country:US
Practice Address - Phone:662-617-4626
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-10
Last Update Date:2018-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional