Provider Demographics
NPI:1821267097
Name:WITHERS, ANTAWANNA MARSHAY (MHPP)
Entity Type:Individual
Prefix:
First Name:ANTAWANNA
Middle Name:MARSHAY
Last Name:WITHERS
Suffix:
Gender:F
Credentials:MHPP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:139 SOUTH MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:DUMAS
Mailing Address - State:AR
Mailing Address - Zip Code:71639
Mailing Address - Country:US
Mailing Address - Phone:870-382-0735
Mailing Address - Fax:870-382-0738
Practice Address - Street 1:139 SOUTH MAIN STREET
Practice Address - Street 2:
Practice Address - City:DUMAS
Practice Address - State:AR
Practice Address - Zip Code:71639
Practice Address - Country:US
Practice Address - Phone:870-382-0735
Practice Address - Fax:870-382-0738
Is Sole Proprietor?:No
Enumeration Date:2008-02-21
Last Update Date:2008-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator