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General NPI Number Information
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NPI Number | 1578129201
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Entity Type | Organization
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Legal Business Name | CHOSEN ONE PROFESSIONAL SERVICES, LLC.
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Dates
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Enumeration Date | 05/17/2019
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Last Update Date | 05/15/2023
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Provider Practice Location Address
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Address Line | 320 N ROSSER ST
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City | FORREST CITY
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State | AR
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Zip | 72335-3247
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Country | US
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Telephone | 870-510-4981
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 13810
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City | MAUMELLE
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State | AR
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Zip | 72113-0810
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Country | US
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Telephone | 870-519-9482
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Fax | 501-421-3418
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Authorized Official
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Title or Position | CEO/CLINICAL DIRECTOR
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Name | MS. MELRITA MAECHEL JOHNSON
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Credential | LCSW
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Telephone | 870-519-9482
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number |
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License Number State |
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