Healthcare Provider Details

I. General information

NPI: 1053569699
Provider Name (Legal Business Name): CAROLYN EWING LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/08/2008
Last Update Date: 12/14/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1371 HIGHWAY 278 W
MONTICELLO AR
71655-9663
US

IV. Provider business mailing address

5537 BLEAUX AVE
SPRINGDALE AR
72762-0737
US

V. Phone/Fax

Practice location:
  • Phone: 870-367-2143
  • Fax: 870-367-2145
Mailing address:
  • Phone: 479-872-5580
  • Fax: 479-872-5581

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number2116M
License Number StateAR
# 2
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number2408-C
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: