Provider Demographics
NPI:1356411086
Name:MOFFITT-REAVES, CARRIE (LCSW)
Entity type:Individual
Prefix:MRS
First Name:CARRIE
Middle Name:
Last Name:MOFFITT-REAVES
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1815 PLEASANT GROVE RD
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:AR
Mailing Address - Zip Code:72401-7870
Mailing Address - Country:US
Mailing Address - Phone:870-933-6886
Mailing Address - Fax:870-933-9395
Practice Address - Street 1:111 S 3RD AVE
Practice Address - Street 2:
Practice Address - City:PIGGOTT
Practice Address - State:AR
Practice Address - Zip Code:72454-2634
Practice Address - Country:US
Practice Address - Phone:870-598-0306
Practice Address - Fax:870-598-0328
Is Sole Proprietor?:No
Enumeration Date:2006-11-09
Last Update Date:2018-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR2021-C1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR173433795Medicaid
AR5A132OtherBCBS
AR5A132C455Medicare PIN
AR5A132Medicare PIN