Provider Demographics
NPI:1114017035
Name:SHANKLIN, LISA ADRIENNE
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:ADRIENNE
Last Name:SHANKLIN
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 1:16401 CHENAL VALLEY DR
Mailing Address - Street 2:APT 6107
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72223-3905
Mailing Address - Country:US
Mailing Address - Phone:501-448-2462
Mailing Address - Fax:
Practice Address - Street 1:2902 E KIEHL AVE
Practice Address - Street 2:SUITE 1A
Practice Address - City:SHERWOOD
Practice Address - State:AR
Practice Address - Zip Code:72120-3226
Practice Address - Country:US
Practice Address - Phone:501-834-2727
Practice Address - Fax:501-834-2242
Is Sole Proprietor?:No
Enumeration Date:2006-10-13
Last Update Date:2008-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health