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Individual

JACKIE TRICE

Active
Sole proprietor
No

Provider details

NPI number
Gender
F

Contact information

Practice address
712 W 3RD ST, LITTLE ROCK, AR 72201-2220
(501) 379-4246
Mailing address
712 W 3RD ST, LITTLE ROCK, AR 72201-2220

Taxonomy

Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
171M00000X
Case Manager/Care Coordinator

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
171043795
AR
Enumeration date
06/20/2017
Last updated
06/20/2017
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