Provider Demographics
NPI:1801001763
Name:CAROTHERS, JESSE R (LCSW)
Entity Type:Individual
Prefix:
First Name:JESSE
Middle Name:R
Last Name:CAROTHERS
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3103 ALMA HWY
Mailing Address - Street 2:
Mailing Address - City:VAN BUREN
Mailing Address - State:AR
Mailing Address - Zip Code:72956-5027
Mailing Address - Country:US
Mailing Address - Phone:479-474-4483
Mailing Address - Fax:479-262-5041
Practice Address - Street 1:3103 ALMA HWY
Practice Address - Street 2:
Practice Address - City:VAN BUREN
Practice Address - State:AR
Practice Address - Zip Code:72956-5027
Practice Address - Country:US
Practice Address - Phone:479-474-4483
Practice Address - Fax:479-262-5041
Is Sole Proprietor?:No
Enumeration Date:2007-05-14
Last Update Date:2023-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical