Provider Demographics
NPI:1568248508
Name:AMANDA EMERSON, P.A.
Entity Type:Organization
Organization Name:AMANDA EMERSON, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:SUE
Authorized Official - Last Name:EMERSON
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:870-351-4565
Mailing Address - Street 1:361 SOUTHWEST DR # 133
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:AR
Mailing Address - Zip Code:72401-5854
Mailing Address - Country:US
Mailing Address - Phone:870-351-4565
Mailing Address - Fax:870-206-8213
Practice Address - Street 1:2020 W 3RD ST STE 601B
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205-4467
Practice Address - Country:US
Practice Address - Phone:870-206-8212
Practice Address - Fax:870-206-8213
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-06
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty