Healthcare Provider Details

I. General information

NPI: 1912530692
Provider Name (Legal Business Name): ABBY MIX LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/20/2020
Last Update Date: 09/22/2025
Certification Date: 09/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6801 ISAACS ORCHARD RD STE 215
SPRINGDALE AR
72762-6799
US

IV. Provider business mailing address

6801 ISAACS ORCHARD RD STE 215
SPRINGDALE AR
72762-6799
US

V. Phone/Fax

Practice location:
  • Phone: 479-341-5238
  • Fax:
Mailing address:
  • Phone: 479-341-5238
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number8416-C
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: