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General NPI Number Information
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NPI Number | 1750121885
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Entity Type | Individual
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Provider Name | MARIAH STOKES
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Gender | Female
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Dates
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Enumeration Date | 05/28/2024
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Last Update Date | 10/16/2024
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Provider Practice Location Address
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Address Line | 205 W BOND AVE
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City | WEST MEMPHIS
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State | AR
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Zip | 72301
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Country | US
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Telephone | 901-216-5076
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 11064
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City | FAYETTEVILLE
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State | AR
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Zip | 72703-1001
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Country | US
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Telephone | 870-520-5014
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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 | 104100000X
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Taxonomy Name | Social Worker
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License Number | 22403-M
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License Number State | AR
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