Provider Demographics
NPI:1235593377
Name:MORGAN, WILLICA ETISHA (MS, LPC)
Entity Type:Individual
Prefix:MRS
First Name:WILLICA
Middle Name:ETISHA
Last Name:MORGAN
Suffix:
Gender:F
Credentials:MS, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:103 ELM ST
Mailing Address - Street 2:
Mailing Address - City:ARKADELPHIA
Mailing Address - State:AR
Mailing Address - Zip Code:71923-6659
Mailing Address - Country:US
Mailing Address - Phone:870-293-2042
Mailing Address - Fax:870-293-2050
Practice Address - Street 1:103 ELM ST
Practice Address - Street 2:
Practice Address - City:ARKADELPHIA
Practice Address - State:AR
Practice Address - Zip Code:71923-6659
Practice Address - Country:US
Practice Address - Phone:870-200-9472
Practice Address - Fax:870-617-7003
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-05
Last Update Date:2023-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARP150541101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOPENDINGMedicaid