Provider Demographics
NPI:1093743429
Name:HENLEY, VICKI L (LCSW)
Entity Type:Individual
Prefix:
First Name:VICKI
Middle Name:L
Last Name:HENLEY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:VICKI
Other - Middle Name:L
Other - Last Name:SHARP
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2453 N CROSSOVER RD
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72703-4326
Mailing Address - Country:US
Mailing Address - Phone:479-521-5731
Mailing Address - Fax:479-521-4926
Practice Address - Street 1:702 N MAIN ST
Practice Address - Street 2:SUITE C
Practice Address - City:HARRISON
Practice Address - State:AR
Practice Address - Zip Code:72601-2900
Practice Address - Country:US
Practice Address - Phone:870-741-2658
Practice Address - Fax:870-741-2722
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR2023C1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5Y815OtherBLUE CROSS
AR5Y815Medicare ID - Type Unspecified