Provider Demographics
NPI:1497110043
Name:REDDIN, KEENA MICHELLE (LCSW)
Entity Type:Individual
Prefix:
First Name:KEENA
Middle Name:MICHELLE
Last Name:REDDIN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:218 UNION ST STE C
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:AR
Mailing Address - Zip Code:72401-2831
Mailing Address - Country:US
Mailing Address - Phone:870-530-6104
Mailing Address - Fax:888-528-5016
Practice Address - Street 1:218 UNION ST STE C
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:AR
Practice Address - Zip Code:72401-2831
Practice Address - Country:US
Practice Address - Phone:870-530-6104
Practice Address - Fax:888-528-5016
Is Sole Proprietor?:No
Enumeration Date:2015-12-28
Last Update Date:2020-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR6572-C1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical