Provider Demographics
NPI:1497041321
Name:NORRIS, LAQUITA SHANA (MSW, LCSW)
Entity Type:Individual
Prefix:MRS
First Name:LAQUITA
Middle Name:SHANA
Last Name:NORRIS
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:MISS
Other - First Name:LAQUITA
Other - Middle Name:SHANA
Other - Last Name:COOK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1920 CONGO RD STE A
Mailing Address - Street 2:
Mailing Address - City:BENTON
Mailing Address - State:AR
Mailing Address - Zip Code:72015-2884
Mailing Address - Country:US
Mailing Address - Phone:501-425-6476
Mailing Address - Fax:501-358-3095
Practice Address - Street 1:1920 CONGO RD STE A
Practice Address - Street 2:
Practice Address - City:BENTON
Practice Address - State:AR
Practice Address - Zip Code:72015-2884
Practice Address - Country:US
Practice Address - Phone:501-425-6476
Practice Address - Fax:501-358-3095
Is Sole Proprietor?:No
Enumeration Date:2011-06-20
Last Update Date:2020-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR5133-C1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical