Provider Demographics
NPI:1912388877
Name:MONK, MIRACLE (MSW)
Entity Type:Individual
Prefix:
First Name:MIRACLE
Middle Name:
Last Name:MONK
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2500 RIKE DR
Mailing Address - Street 2:
Mailing Address - City:PINE BLUFF
Mailing Address - State:AR
Mailing Address - Zip Code:71603-3937
Mailing Address - Country:US
Mailing Address - Phone:870-534-1834
Mailing Address - Fax:870-534-5798
Practice Address - Street 1:121 COMMERCIAL DR # B
Practice Address - Street 2:
Practice Address - City:STUTTGART
Practice Address - State:AR
Practice Address - Zip Code:72160-7033
Practice Address - Country:US
Practice Address - Phone:870-673-1633
Practice Address - Fax:870-673-1253
Is Sole Proprietor?:No
Enumeration Date:2015-06-16
Last Update Date:2023-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPLMSW101YM0800X
171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR224389795Medicaid