MEDICARE: MRS. CHANDA CAMDEN LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	1809-M	AR
2	1041C0700X	Clinical Social Worker	2437-C	AR

General Provider Information

NPI Number	:	1336289453
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. CHANDA CAMDEN LCSW

Provider Business Mailing Address
First Line	:	401 W CAPITOL AVE
Second Line	:	SUITE 301
City	:	LITTLE ROCK
State	:	AR
Zip	:	72201-3421
Country	:	US
Telephone Number	:	501-975-0009
Fax Number	:	501-975-0009

Provider Business Practice Location Address
First Line	:	401 W CAPITOL AVE
Second Line	:	SUITE 301
City	:	LITTLE ROCK
State	:	AR
Zip	:	72201-3421
Country	:	US
Telephone Number	:	501-975-0009
Fax Number	:	501-975-0009

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/07/2007
Last Update Date	:	10/20/2010

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