Individual
MRS. IDA LATRECIA FOGLE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
1100 W 2ND ST, LITTLE ROCK, AR 72201-2004
(501) 257-4399
(501) 257-4235
Mailing address
17 LAKESIDE DR, LITTLE ROCK, AR 72204-8405
(501) 257-4399
(501) 257-4235
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
1982-C
AR
Other
Enumeration date
08/15/2006
Last updated
07/08/2007
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