Provider Demographics
NPI:1326700055
Name:DAVIS-CARLSON, MAEGAN (LMSW)
Entity Type:Individual
Prefix:
First Name:MAEGAN
Middle Name:
Last Name:DAVIS-CARLSON
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:MAEGAN
Other - Middle Name:
Other - Last Name:CARLSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LMSW
Mailing Address - Street 1:PO BOX 11064
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72703-1001
Mailing Address - Country:US
Mailing Address - Phone:870-271-9293
Mailing Address - Fax:
Practice Address - Street 1:1792 FALLS BLVD N
Practice Address - Street 2:
Practice Address - City:WYNNE
Practice Address - State:AR
Practice Address - Zip Code:72396-4092
Practice Address - Country:US
Practice Address - Phone:870-271-9293
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-11
Last Update Date:2024-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR11404-M104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker