Healthcare Provider Details

I. General information

NPI: 1942872775
Provider Name (Legal Business Name): MOLLEE BROOKE MCCLAIN LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/12/2021
Last Update Date: 11/21/2022
Certification Date: 11/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2508 CRESTWOOD RD
NORTH LITTLE ROCK AR
72116-7623
US

IV. Provider business mailing address

11001 EXECUTIVE CENTER DR STE 200
LITTLE ROCK AR
72211-4393
US

V. Phone/Fax

Practice location:
  • Phone: 501-758-2294
  • Fax: 501-758-7877
Mailing address:
  • Phone: 501-487-6010
  • Fax: 501-202-7513

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number10036-M
License Number StateAR
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number10036-C
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: