Provider Demographics
NPI:1083741607
Name:EDMISTON, ROBIN LESLIE (LMSW)
Entity Type:Individual
Prefix:
First Name:ROBIN
Middle Name:LESLIE
Last Name:EDMISTON
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 148
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:AR
Mailing Address - Zip Code:72364-0148
Mailing Address - Country:US
Mailing Address - Phone:870-739-2737
Mailing Address - Fax:
Practice Address - Street 1:3998 HIGHWAY 1 N
Practice Address - Street 2:
Practice Address - City:FORREST CITY
Practice Address - State:AR
Practice Address - Zip Code:72335-7637
Practice Address - Country:US
Practice Address - Phone:870-633-8780
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-28
Last Update Date:2008-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR1812-M104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker