Individual
MIKE KNICKERBOCKER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LADAC
Contact information
Practice address
412 YORK ST, WARREN, AR 71671-3218
(870) 226-9970
(870) 226-9972
Mailing address
412 YORK ST, WARREN, AR 71671-3218
(870) 226-9970
(870) 226-9972
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
0159L
AR
101YA0400X
Addiction (Substance Use Disorder) Counselor
A-194
AR
Other
Enumeration date
06/27/2012
Last updated
06/27/2012
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