Healthcare Provider Details

I. General information

NPI: 1609793843
Provider Name (Legal Business Name): SUNNIE SAMANTHA JANE KECK LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/30/2026
Last Update Date: 06/30/2026
Certification Date: 06/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

106 S SPRING ST
SEARCY AR
72143-7717
US

IV. Provider business mailing address

119 BLACK OAK PL
SEARCY AR
72143-7737
US

V. Phone/Fax

Practice location:
  • Phone: 501-658-3717
  • Fax:
Mailing address:
  • Phone: 501-658-3717
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number5475-C
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: