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Individual

ITALIA BUSTAMANTE-QUINTANA

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
LMSW

Contact information

Practice address
1312 W COLLIN RAYE DR, DE QUEEN, AR 71832-2135
(870) 777-9051
Mailing address
2904 ARKANSAS BLVD, TEXARKANA, AR 71854-2536
(870) 773-4655
(870) 772-4650

Taxonomy

Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
PLMSW
AR
1041C0700X
Clinical Social Worker
PLMSW
AR

Other

Enumeration date
08/24/2021
Last updated
08/24/2021
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