Healthcare Provider Details

I. General information

NPI: 1982531679
Provider Name (Legal Business Name): TACARRA MICHELLE GOODWIN LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/06/2026
Last Update Date: 05/06/2026
Certification Date: 05/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2910 E HARDING AVE # 1064
PINE BLUFF AR
71601-6853
US

IV. Provider business mailing address

2910 E HARDING AVE # 1064
PINE BLUFF AR
71601-6853
US

V. Phone/Fax

Practice location:
  • Phone: 870-487-1707
  • Fax:
Mailing address:
  • Phone: 870-487-1707
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number11150-C
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: