Provider Demographics
NPI:1346501624
Name:FRAZIER-HENSON, ANGELIA MICHELLE (LMSW)
Entity Type:Individual
Prefix:
First Name:ANGELIA
Middle Name:MICHELLE
Last Name:FRAZIER-HENSON
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:ANGELIA
Other - Middle Name:MICHELLE
Other - Last Name:BUFORD
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LMSW
Mailing Address - Street 1:201 S ROSE ST
Mailing Address - Street 2:
Mailing Address - City:SHERIDAN
Mailing Address - State:AR
Mailing Address - Zip Code:72150-2451
Mailing Address - Country:US
Mailing Address - Phone:870-917-2171
Mailing Address - Fax:870-917-2161
Practice Address - Street 1:201 S ROSE ST
Practice Address - Street 2:
Practice Address - City:SHERIDAN
Practice Address - State:AR
Practice Address - Zip Code:72150-2451
Practice Address - Country:US
Practice Address - Phone:870-917-2171
Practice Address - Fax:870-917-2161
Is Sole Proprietor?:No
Enumeration Date:2012-06-04
Last Update Date:2014-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR3397-M104100000X, 104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker