Provider Demographics
NPI:1497074165
Name:CLARK, TOMEIKA LESHAUNDIA (PLMSW)
Entity Type:Individual
Prefix:MRS
First Name:TOMEIKA
Middle Name:LESHAUNDIA
Last Name:CLARK
Suffix:
Gender:F
Credentials:PLMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5537 BLEAUX AVE
Mailing Address - Street 2:
Mailing Address - City:SPRINGDALE
Mailing Address - State:AR
Mailing Address - Zip Code:72762-0737
Mailing Address - Country:US
Mailing Address - Phone:870-530-5243
Mailing Address - Fax:
Practice Address - Street 1:5537 BLEAUX AVE
Practice Address - Street 2:
Practice Address - City:SPRINGDALE
Practice Address - State:AR
Practice Address - Zip Code:72762-0737
Practice Address - Country:US
Practice Address - Phone:870-530-5243
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-20
Last Update Date:2011-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker