Provider Demographics
NPI:1659701654
Name:EMERSON, AMANDA SUE (LCSW)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:SUE
Last Name:EMERSON
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 1:361 SOUTHWEST DR UNIT 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:
Practice Address - Street 1:2020 W 3RD ST STE 605B
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205-4461
Practice Address - Country:US
Practice Address - Phone:870-206-8212
Practice Address - Fax:870-206-8213
Is Sole Proprietor?:No
Enumeration Date:2013-11-13
Last Update Date:2023-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR8606-C1041C0700X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical