Provider Demographics
NPI:1790030351
Name:LITZSEY, CARLA N
Entity Type:Individual
Prefix:
First Name:CARLA
Middle Name:N
Last Name:LITZSEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7101 W 12TH ST STE 201
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72204-2404
Mailing Address - Country:US
Mailing Address - Phone:501-663-1837
Mailing Address - Fax:501-663-1839
Practice Address - Street 1:7101 W 12TH ST STE 201
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72204-2404
Practice Address - Country:US
Practice Address - Phone:501-663-1837
Practice Address - Fax:501-663-1839
Is Sole Proprietor?:No
Enumeration Date:2012-07-19
Last Update Date:2017-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator