Healthcare Provider Details

I. General information

NPI: 1295409431
Provider Name (Legal Business Name): MICKEY CHAUDOIN LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/02/2021
Last Update Date: 07/06/2026
Certification Date: 07/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 S RODNEY PARHAM RD STE 1 PMB #167
LITTLE ROCK AR
72205-4776
US

IV. Provider business mailing address

300 S RODNEY PARHAM RD. SUITE 1 PMB #167
LITTLE ROCK AR
72205
US

V. Phone/Fax

Practice location:
  • Phone: 870-393-6328
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number12686-C
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: