Provider Demographics
NPI:1083822605
Name:POWELL, AMBER
Entity Type:Individual
Prefix:MRS
First Name:AMBER
Middle Name:
Last Name:POWELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3100 APACHE DRIVE
Mailing Address - Street 2:ARKIDS PEDIATRIC DAY CENTERS
Mailing Address - City:JONESBORO
Mailing Address - State:AR
Mailing Address - Zip Code:72401
Mailing Address - Country:US
Mailing Address - Phone:870-333-5437
Mailing Address - Fax:870-333-5237
Practice Address - Street 1:3100 APACHE DRIVE
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:AR
Practice Address - Zip Code:72401
Practice Address - Country:US
Practice Address - Phone:870-333-5437
Practice Address - Fax:870-333-5237
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-18
Last Update Date:2023-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPLMSW1041C0700X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical