Provider Demographics
NPI:1720538069
Name:DUNCAN, KENYA NICHELLE (LCSW)
Entity Type:Individual
Prefix:
First Name:KENYA
Middle Name:NICHELLE
Last Name:DUNCAN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:KENYA
Other - Middle Name:NICHELLE
Other - Last Name:DUNCAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2809 FOREST HOME RD
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:AR
Mailing Address - Zip Code:72401-5320
Mailing Address - Country:US
Mailing Address - Phone:870-972-1268
Mailing Address - Fax:870-934-0847
Practice Address - Street 1:2200 E MATTHEWS AVE
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:AR
Practice Address - Zip Code:72401-4347
Practice Address - Country:US
Practice Address - Phone:870-972-1268
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-11
Last Update Date:2020-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR216138795Medicaid