Basic Information
| Provider Information | |||||||||
| NPI: | 1881712891 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MIXON | ||||||||
| FirstName: | CAROLYN | ||||||||
| MiddleName: | D | ||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | LCSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 700 GRAND POINT DR | ||||||||
| Address2: | |||||||||
| City: | HOT SPRINGS | ||||||||
| State: | AR | ||||||||
| PostalCode: | 719018922 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5015208064 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 106 RIDGEWAY ST | ||||||||
| Address2: | SUITE G & H | ||||||||
| City: | HOT SPRINGS | ||||||||
| State: | AR | ||||||||
| PostalCode: | 719017100 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5016090400 | ||||||||
| FaxNumber: | 5016090166 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/27/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 104100000X | C648 | AR | Y | Behavioral Health & Social Service Providers | Social Worker |
No ID Information.