Provider Demographics
NPI:1760647499
Name:KIGHT, CHARLA NICOLE (LAC)
Entity Type:Individual
Prefix:
First Name:CHARLA
Middle Name:NICOLE
Last Name:KIGHT
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:701 WELLINGTON HILLS RD
Mailing Address - Street 2:APT. 714
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72211-2172
Mailing Address - Country:US
Mailing Address - Phone:501-364-5150
Mailing Address - Fax:501-364-1592
Practice Address - Street 1:1120 MARSHALL ST
Practice Address - Street 2:SLOT 654
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72202-4610
Practice Address - Country:US
Practice Address - Phone:501-364-5150
Practice Address - Fax:501-364-1592
Is Sole Proprietor?:No
Enumeration Date:2008-07-22
Last Update Date:2008-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA0805033101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health