Healthcare Provider Details

I. General information

NPI: 1790161909
Provider Name (Legal Business Name): LATOYA MCCOY-CRISWELL LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/11/2015
Last Update Date: 04/17/2025
Certification Date: 04/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3240 STERMER RD
CONWAY AR
72034-5532
US

IV. Provider business mailing address

3240 STERMER RD
CONWAY AR
72034-5532
US

V. Phone/Fax

Practice location:
  • Phone: 479-968-1298
  • Fax: 479-968-6053
Mailing address:
  • Phone: 479-968-1298
  • Fax: 479-968-6053

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: