Provider Demographics
NPI:1093280554
Name:O'GUINN, SASHA REYNA (LMSW)
Entity Type:Individual
Prefix:
First Name:SASHA
Middle Name:REYNA
Last Name:O'GUINN
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:SASHA
Other - Middle Name:REYNA
Other - Last Name:GIPSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMSW
Mailing Address - Street 1:1600 ALDERSGATE RD STE 200
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72205-6676
Mailing Address - Country:US
Mailing Address - Phone:501-661-0720
Mailing Address - Fax:
Practice Address - Street 1:2305 FOX MEADOW LN
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:AR
Practice Address - Zip Code:72404-9344
Practice Address - Country:US
Practice Address - Phone:870-910-3757
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-10
Last Update Date:2023-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR9563-M104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR230051795Medicaid