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General NPI Number Information
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NPI Number | 1619947447
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Entity Type | Individual
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Provider Name | CATHERINE STALLARD LCSW
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Gender | Female
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Dates
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Enumeration Date | 01/24/2006
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Last Update Date | 10/04/2022
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Provider Practice Location Address
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Address Line | 304 W COLLIN RAYE DR STE 103A
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City | DE QUEEN
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State | AR
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Zip | 71832-2000
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Country | US
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Telephone | 870-330-4460
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Fax | 870-330-4460
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Provider Business Mailing Address
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Address Line | 1015 E 35TH ST
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City | TEXARKANA
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State | AR
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Zip | 71854-2745
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Country | US
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Telephone | 870-330-4460
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Fax | 870-330-4460
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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 | 881-C
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License Number State | AR
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