Provider Demographics
NPI:1447240387
Name:HASKINS, TERI E (LCSW, ACSW, QCSW)
Entity Type:Individual
Prefix:MS
First Name:TERI
Middle Name:E
Last Name:HASKINS
Suffix:
Gender:F
Credentials:LCSW, ACSW, QCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2723 FOXCROFT RD
Mailing Address - Street 2:SUITE 310
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72227-6517
Mailing Address - Country:US
Mailing Address - Phone:501-221-2222
Mailing Address - Fax:501-228-0912
Practice Address - Street 1:2723 FOXCROFT RD
Practice Address - Street 2:SUITE 310
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72227-6517
Practice Address - Country:US
Practice Address - Phone:501-221-2222
Practice Address - Fax:501-228-0912
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARAR 110C1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5S007Medicare ID - Type Unspecified