Healthcare Provider Details

I. General information

NPI: 1922218254
Provider Name (Legal Business Name): SHAKIRA MICHELLE EAKINS LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/23/2007
Last Update Date: 02/24/2023
Certification Date: 02/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

395 SCHAEFER CT
PEA RIDGE AR
72751-3331
US

IV. Provider business mailing address

395 SCHAEFER CT
PEA RIDGE AR
72751-3331
US

V. Phone/Fax

Practice location:
  • Phone: 479-544-8662
  • Fax:
Mailing address:
  • Phone: 479-544-8662
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number2650-M
License Number StateAR
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number3821-C
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: