MEDICARE: NICHOLLE DORN 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	1041C0700X	Clinical Social Worker	3785-C	AR

General Provider Information

NPI Number	:	1750050936
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NICHOLLE DORN LCSW

Provider Business Mailing Address
First Line	:	910 S ROGERS ST STE E
Second Line	:
City	:	CLARKSVILLE
State	:	AR
Zip	:	72830-4331
Country	:	US
Telephone Number	:	479-335-5747
Fax Number	:	479-957-9083

Provider Business Practice Location Address
First Line	:	910 S ROGERS ST STE E
Second Line	:
City	:	CLARKSVILLE
State	:	AR
Zip	:	72830-4331
Country	:	US
Telephone Number	:	479-335-5747
Fax Number	:	479-957-9083

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

Provider Enumeration Date	:	09/10/2021
Last Update Date	:	06/10/2026

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Directions to “ NICHOLLE DORN LCSW” Practice Location

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