Provider Demographics
NPI:1104442565
Name:BASS-CARRIGAN, DEANDRIEA (PHD)
Entity type:Individual
Prefix:
First Name:DEANDRIEA
Middle Name:
Last Name:BASS-CARRIGAN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1570 RACHEL DR
Mailing Address - Street 2:
Mailing Address - City:CONWAY
Mailing Address - State:AR
Mailing Address - Zip Code:72032-8619
Mailing Address - Country:US
Mailing Address - Phone:501-269-1163
Mailing Address - Fax:
Practice Address - Street 1:1570 RACHEL DR
Practice Address - Street 2:
Practice Address - City:CONWAY
Practice Address - State:AR
Practice Address - Zip Code:72032-8619
Practice Address - Country:US
Practice Address - Phone:501-269-1163
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-22
Last Update Date:2024-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARP2102154101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional