Provider Demographics
NPI:1124851563
Name:WHITESIDE, CASSANDRA (LMSW)
Entity type:Individual
Prefix:
First Name:CASSANDRA
Middle Name:
Last Name:WHITESIDE
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8404 BASELINE RD
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72209-4339
Mailing Address - Country:US
Mailing Address - Phone:501-663-0708
Mailing Address - Fax:
Practice Address - Street 1:8404 BASELINE RD
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72209-4339
Practice Address - Country:US
Practice Address - Phone:501-663-0708
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-21
Last Update Date:2024-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker