Provider Demographics
NPI:1700110558
Name:MCCORKINDALE, AMANDA CLARE (PSYD)
Entity Type:Individual
Prefix:MS
First Name:AMANDA
Middle Name:CLARE
Last Name:MCCORKINDALE
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2200 FORT ROOTS DR
Mailing Address - Street 2:
Mailing Address - City:NORTH LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72114-1709
Mailing Address - Country:US
Mailing Address - Phone:501-257-3925
Mailing Address - Fax:501-257-2026
Practice Address - Street 1:2200 FORT ROOTS DR
Practice Address - Street 2:
Practice Address - City:NORTH LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72114-1709
Practice Address - Country:US
Practice Address - Phone:501-257-3925
Practice Address - Fax:501-257-2026
Is Sole Proprietor?:No
Enumeration Date:2009-09-28
Last Update Date:2021-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR12-03P103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist