Individual
CRISTINA PUCKETT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
1401 MALVERN AVE STE 152, HOT SPRINGS, AR 71901-6370
(501) 463-0209
Mailing address
PO BOX 20512, HOT SPRINGS, AR 71903-0512
(501) 463-0209
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
9805-M
AR
1041C0700X
Clinical Social Worker
Primary
9805-C
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
289620719
—
AR
Enumeration date
12/30/2019
Last updated
12/07/2023
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