Provider Demographics
NPI:1720405244
Name:PHIFER, AVIS K (PLMSW)
Entity Type:Individual
Prefix:MRS
First Name:AVIS
Middle Name:K
Last Name:PHIFER
Suffix:
Gender:F
Credentials:PLMSW
Other - Prefix:MS
Other - First Name:AVIS
Other - Middle Name:K
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 1987
Mailing Address - Street 2:
Mailing Address - City:TEXARKANA
Mailing Address - State:TX
Mailing Address - Zip Code:75504-1987
Mailing Address - Country:US
Mailing Address - Phone:870-773-4655
Mailing Address - Fax:870-772-4640
Practice Address - Street 1:2904 ARKANSAS BLVD
Practice Address - Street 2:
Practice Address - City:TEXARKANA
Practice Address - State:AR
Practice Address - Zip Code:71854-2536
Practice Address - Country:US
Practice Address - Phone:870-773-4655
Practice Address - Fax:870-772-4640
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-21
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPLMSW104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker