Provider Demographics
NPI:1467643783
Name:OWENS, AMANDA G (MSW, LCSW)
Entity Type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:G
Last Name:OWENS
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:650 S SHACKLEFORD RD
Mailing Address - Street 2:SUITE 217
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72211-3522
Mailing Address - Country:US
Mailing Address - Phone:501-221-1843
Mailing Address - Fax:501-221-2376
Practice Address - Street 1:109 N HAZEN AVE
Practice Address - Street 2:
Practice Address - City:HAZEN
Practice Address - State:AR
Practice Address - Zip Code:72064
Practice Address - Country:US
Practice Address - Phone:870-255-3527
Practice Address - Fax:870-255-3528
Is Sole Proprietor?:No
Enumeration Date:2007-08-05
Last Update Date:2007-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR1868-C1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5X889Medicare PIN