Provider Demographics
NPI:1730842717
Name:BUCHANAN, ASTAZZIA SHARDAE (PLMSW)
Entity type:Individual
Prefix:
First Name:ASTAZZIA
Middle Name:SHARDAE
Last Name:BUCHANAN
Suffix:
Gender:F
Credentials:PLMSW
Other - Prefix:
Other - First Name:ASTAZZIA
Other - Middle Name:
Other - Last Name:BUCHANAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 251970
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72225-1970
Mailing Address - Country:US
Mailing Address - Phone:501-666-8686
Mailing Address - Fax:501-660-6829
Practice Address - Street 1:6601 WEST 12TH STREET
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72204-1513
Practice Address - Country:US
Practice Address - Phone:501-666-8686
Practice Address - Fax:501-660-6830
Is Sole Proprietor?:No
Enumeration Date:2021-10-18
Last Update Date:2025-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR171M00000X
ARPLMSW104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR236900526Medicaid