Healthcare Provider Details

I. General information

NPI: 1962585901
Provider Name (Legal Business Name): HOLLY POINDEXTER L.C.S.W.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/23/2006
Last Update Date: 10/22/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2796 S 2ND ST STE E
CABOT AR
72023-7043
US

IV. Provider business mailing address

2796 S 2ND ST STE E
CABOT AR
72023-7043
US

V. Phone/Fax

Practice location:
  • Phone: 501-286-6086
  • Fax: 501-286-6046
Mailing address:
  • Phone: 501-286-6086
  • Fax: 501-286-6046

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number5289-C
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: