Individual
TRACY AMANDA WADDLE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
4354 STOCKTON DR, NORTH LITTLE ROCK, AR 72117-2917
(501) 955-7600
(501) 955-7612
Mailing address
650 S SHACKLEFORD RD, SUITE 217, LITTLE ROCK, AR 72211-3522
(501) 221-1843
(501) 221-2376
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
2017-C
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
5Y892
ARKANSAS BCBS
AR
Enumeration date
08/18/2006
Last updated
07/08/2007
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