Provider Demographics
NPI:1700193059
Name:ARKADIE, SHIRLEY KAYE (LCDC)
Entity Type:Individual
Prefix:MS
First Name:SHIRLEY
Middle Name:KAYE
Last Name:ARKADIE
Suffix:
Gender:F
Credentials:LCDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1012 W MACARTHUR AVE
Mailing Address - Street 2:
Mailing Address - City:ODESSA
Mailing Address - State:TX
Mailing Address - Zip Code:79763-3341
Mailing Address - Country:US
Mailing Address - Phone:432-335-9659
Mailing Address - Fax:432-580-2609
Practice Address - Street 1:401 E ILLINOIS AVE
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:TX
Practice Address - Zip Code:79701-4803
Practice Address - Country:US
Practice Address - Phone:432-570-3300
Practice Address - Fax:432-570-3375
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-08
Last Update Date:2010-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10135101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)