Individual
CARISSA BACON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
304 N 6TH ST, WEST MEMPHIS, AR 72301-3221
(870) 732-1878
(870) 702-7111
Mailing address
703 CALVIN AVERY DR, SUITE A, WEST MEMPHIS, AR 72301-6501
(870) 792-7769
(870) 792-7561
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
—
—
Other
Enumeration date
05/09/2014
Last updated
06/06/2017
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