Healthcare Provider Details

I. General information

NPI: 1114894391
Provider Name (Legal Business Name): CORRINA NICOLE LOCKHART LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/21/2025
Last Update Date: 09/06/2026
Certification Date: 09/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 S RHODES ST STE E
WEST MEMPHIS AR
72301-4213
US

IV. Provider business mailing address

200 S RHODES ST STE E
WEST MEMPHIS AR
72301-4213
US

V. Phone/Fax

Practice location:
  • Phone: 870-394-4116
  • Fax:
Mailing address:
  • Phone: 870-394-4116
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number22655-C
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: