Basic Information
| Provider Information | |||||||||
| NPI: | 1033879465 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | NEAL | ||||||||
| FirstName: | TIFFANY | ||||||||
| MiddleName: | NIKKI | ||||||||
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| Credential: | LMSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1254 | ||||||||
| Address2: | |||||||||
| City: | JONESBORO | ||||||||
| State: | AR | ||||||||
| PostalCode: | 724031254 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8704972650 | ||||||||
| FaxNumber: | 8702774060 | ||||||||
| Practice Location | |||||||||
| Address1: | 9101 N RODNEY PARHAM RD STE B | ||||||||
| Address2: | |||||||||
| City: | LITTLE ROCK | ||||||||
| State: | AR | ||||||||
| PostalCode: | 722051685 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5013898100 | ||||||||
| FaxNumber: | 8889772956 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/27/2021 | ||||||||
| LastUpdateDate: | 12/27/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 12/27/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 104100000X | 10090-M | AR | Y | Behavioral Health & Social Service Providers | Social Worker |
No ID Information.