Provider Demographics
NPI:1396574679
Name:CHAKWERA, MARLYN
Entity type:Individual
Prefix:
First Name:MARLYN
Middle Name:
Last Name:CHAKWERA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MARLYN
Other - Middle Name:
Other - Last Name:CHIMOMBO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1909 S ARCH ST
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72206-1343
Mailing Address - Country:US
Mailing Address - Phone:630-812-8010
Mailing Address - Fax:
Practice Address - Street 1:4301 W MARKHAM ST # 568
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205-7101
Practice Address - Country:US
Practice Address - Phone:501-320-7302
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-26
Last Update Date:2024-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR202329103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical