Provider Demographics
NPI:1508885161
Name:HAMPTON, KEA REA (LCSW)
Entity Type:Individual
Prefix:
First Name:KEA
Middle Name:REA
Last Name:HAMPTON
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 1:304 W SAINT LOUIS ST
Mailing Address - Street 2:
Mailing Address - City:HOT SPRINGS
Mailing Address - State:AR
Mailing Address - Zip Code:71913-4406
Mailing Address - Country:US
Mailing Address - Phone:501-625-7000
Mailing Address - Fax:501-625-3070
Practice Address - Street 1:304 W SAINT LOUIS ST
Practice Address - Street 2:
Practice Address - City:HOT SPRINGS
Practice Address - State:AR
Practice Address - Zip Code:71913-4406
Practice Address - Country:US
Practice Address - Phone:501-625-7000
Practice Address - Fax:501-625-3070
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR1607-C1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5W353Medicare ID - Type UnspecifiedMEDICARE AND BCBS