Provider Demographics
NPI:1528379427
Name:CLARDY-WITT, TONI TANEE (MHPP LRSB)
Entity Type:Individual
Prefix:MRS
First Name:TONI
Middle Name:TANEE
Last Name:CLARDY-WITT
Suffix:
Gender:F
Credentials:MHPP LRSB
Other - Prefix:
Other - First Name:TONI
Other - Middle Name:
Other - Last Name:CLARDY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:10025 WEST MARKHAM ST
Mailing Address - Street 2:SUITE 210
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72205
Mailing Address - Country:US
Mailing Address - Phone:501-663-5473
Mailing Address - Fax:501-801-1816
Practice Address - Street 1:10025 WEST MARKHAM ST
Practice Address - Street 2:SUITE 210
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205
Practice Address - Country:US
Practice Address - Phone:501-663-5473
Practice Address - Fax:501-801-1816
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-24
Last Update Date:2016-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health