Individual
NICOLE MEDINA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
2705 OAK LN, VAN BUREN, AR 72956-4816
(479) 471-5950
(479) 471-5997
Mailing address
PO BOX 11818, FORT SMITH, AR 72917-1818
(479) 452-6650
(479) 452-5847
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
12122C
AR
Other
Enumeration date
01/02/2024
Last updated
11/05/2025
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