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General NPI Number Information
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NPI Number | 1447427042
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Entity Type | Individual
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Provider Name | SHAWNTALA ANTOINETTE RICHMOND LCSW
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Gender | Female
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Dates
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Enumeration Date | 05/13/2008
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Last Update Date | 05/13/2008
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Provider Practice Location Address
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Address Line | 4300 W 7TH ST
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City | LITTLE ROCK
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State | AR
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Zip | 72205-5446
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Country | US
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Telephone | 501-257-1000
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Fax |
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Provider Business Mailing Address
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Address Line | 1604 W 58TH ST
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City | NORTH LITTLE ROCK
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State | AR
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Zip | 72118-2912
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Country | US
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Telephone | 501-812-0507
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 2109-C
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License Number State | AR
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