Healthcare Provider Details

I. General information

NPI: 1760595995
Provider Name (Legal Business Name): EDDIE B CARR LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/15/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6210 DOLLARWAY RD SUITE4
PINE BLUFF AR
71602-3733
US

IV. Provider business mailing address

6210 DOLLARWAY RD SUITE4
PINE BLUFF AR
71602-3733
US

V. Phone/Fax

Practice location:
  • Phone: 870-247-3588
  • Fax: 870-247-2072
Mailing address:
  • Phone: 870-247-3588
  • Fax: 870-247-2072

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number1422-C
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: