MEDICARE: MS. TERI E. HASKINS LCSW, ACSW, QCSW

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	1041C0700X	Clinical Social Worker	AR 110C	AR

General Provider Information

NPI Number	:	1447240387
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. TERI E. HASKINS LCSW, ACSW, QCSW

Provider Business Mailing Address
First Line	:	2723 FOXCROFT RD
Second Line	:	SUITE 310
City	:	LITTLE ROCK
State	:	AR
Zip	:	72227-6517
Country	:	US
Telephone Number	:	501-221-2222
Fax Number	:	501-228-0912

Provider Business Practice Location Address
First Line	:	2723 FOXCROFT RD
Second Line	:	SUITE 310
City	:	LITTLE ROCK
State	:	AR
Zip	:	72227-6517
Country	:	US
Telephone Number	:	501-221-2222
Fax Number	:	501-228-0912

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

Provider Enumeration Date	:	10/23/2005
Last Update Date	:	07/08/2007

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