Healthcare Provider Details

I. General information

NPI: 1710016662
Provider Name (Legal Business Name): MELANIE L COOK-DOBBINS LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/05/2007
Last Update Date: 12/28/2024
Certification Date: 12/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3104 S CATALPA ST STE 5
PINE BLUFF AR
71603-4869
US

IV. Provider business mailing address

PO BOX 10689
CONWAY AR
72034-0011
US

V. Phone/Fax

Practice location:
  • Phone: 501-733-5413
  • Fax:
Mailing address:
  • Phone: 501-733-5413
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number3773-C
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: