Provider Demographics
NPI:1881712891
Name:MIXON, CAROLYN D (LCSW)
Entity type:Individual
Prefix:MS
First Name:CAROLYN
Middle Name:D
Last Name:MIXON
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 1:700 GRAND POINT DR
Mailing Address - Street 2:
Mailing Address - City:HOT SPRINGS
Mailing Address - State:AR
Mailing Address - Zip Code:71901-8922
Mailing Address - Country:US
Mailing Address - Phone:501-520-8064
Mailing Address - Fax:
Practice Address - Street 1:106 RIDGEWAY ST
Practice Address - Street 2:SUITE G & H
Practice Address - City:HOT SPRINGS
Practice Address - State:AR
Practice Address - Zip Code:71901-7100
Practice Address - Country:US
Practice Address - Phone:501-609-0400
Practice Address - Fax:501-609-0166
Is Sole Proprietor?:No
Enumeration Date:2007-03-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARC648104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker