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Individual

CONSTANCE MICKENS

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
PLMSW

Contact information

Practice address
304 N 6TH ST, WEST MEMPHIS, AR 72301-3221
(870) 702-7111
Mailing address
703 CALVIN AVERY DR, WEST MEMPHIS, AR 72301-6501
(870) 732-1878
(870) 702-1878

Taxonomy

Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
214805795
AR
Enumeration date
09/14/2016
Last updated
09/14/2016
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