Provider Demographics
NPI:1720312283
Name:CASILLAS, MICHAEL JAMES (LCSW)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:JAMES
Last Name:CASILLAS
Suffix:
Gender:M
Credentials:LCSW
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Other - First Name:
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Mailing Address - Street 1:4260 STOCKTON DR
Mailing Address - Street 2:SUITE A
Mailing Address - City:NORTH LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72117-2915
Mailing Address - Country:US
Mailing Address - Phone:501-916-9129
Mailing Address - Fax:501-916-9129
Practice Address - Street 1:4260 STOCKTON DR
Practice Address - Street 2:SUITE A
Practice Address - City:NORTH LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72117-2915
Practice Address - Country:US
Practice Address - Phone:501-916-9129
Practice Address - Fax:501-916-9770
Is Sole Proprietor?:No
Enumeration Date:2009-09-30
Last Update Date:2014-12-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA295491041C0700X
AR3491-C1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA174400000XOther17-OTHER SERVICES