Healthcare Provider Details

I. General information

NPI: 1033879465
Provider Name (Legal Business Name): TIFFANY NIKKI NEAL LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/27/2021
Last Update Date: 12/27/2021
Certification Date: 12/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9101 N RODNEY PARHAM RD STE B
LITTLE ROCK AR
72205-1685
US

IV. Provider business mailing address

PO BOX 1254
JONESBORO AR
72403-1254
US

V. Phone/Fax

Practice location:
  • Phone: 501-389-8100
  • Fax: 888-977-2956
Mailing address:
  • Phone: 870-497-2650
  • Fax: 870-277-4060

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number10090-M
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: