Provider Demographics
NPI:1275678179
Name:ALCORN, ANTIONNE DEWAYNE (LPC)
Entity Type:Individual
Prefix:MR
First Name:ANTIONNE
Middle Name:DEWAYNE
Last Name:ALCORN
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:607 N 1ST ST STE 4
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72076-4142
Mailing Address - Country:US
Mailing Address - Phone:501-708-5843
Mailing Address - Fax:
Practice Address - Street 1:607 N 1ST ST STE 4
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:AR
Practice Address - Zip Code:72076-4142
Practice Address - Country:US
Practice Address - Phone:501-708-5843
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-20
Last Update Date:2019-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No171M00000XOther Service ProvidersCase Manager/Care Coordinator