Individual
LASONJA HENRY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
620 S LAUREL ST, PINE BLUFF, AR 71601-4859
(870) 534-4900
Mailing address
620 S LAUREL ST, PINE BLUFF, AR 71601-4859
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
7721-M
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
180635526
—
AR
Enumeration date
10/12/2015
Last updated
10/12/2015
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