Provider Demographics
NPI:1285006841
Name:HARRISON, NINA (LCSW)
Entity Type:Individual
Prefix:
First Name:NINA
Middle Name:
Last Name:HARRISON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2809 FOREST HOME RD
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:AR
Mailing Address - Zip Code:72401-5320
Mailing Address - Country:US
Mailing Address - Phone:866-972-1268
Mailing Address - Fax:501-663-2234
Practice Address - Street 1:3358 S 2ND ST STE A-C
Practice Address - Street 2:
Practice Address - City:CABOT
Practice Address - State:AR
Practice Address - Zip Code:72023-7873
Practice Address - Country:US
Practice Address - Phone:501-286-6053
Practice Address - Fax:501-286-6090
Is Sole Proprietor?:No
Enumeration Date:2015-10-22
Last Update Date:2021-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR4236-C1041C0700X
AR2140-M104100000X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR261503719Medicaid
AR101Y00000XMedicaid