Provider Demographics
NPI:1124281209
Name:CONNOR, WINONA GAYLE (LCSW)
Entity type:Individual
Prefix:MS
First Name:WINONA
Middle Name:GAYLE
Last Name:CONNOR
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 1:505 W GRAND AVE
Mailing Address - Street 2:
Mailing Address - City:HOT SPRINGS
Mailing Address - State:AR
Mailing Address - Zip Code:71901-3931
Mailing Address - Country:US
Mailing Address - Phone:501-623-3700
Mailing Address - Fax:
Practice Address - Street 1:1000 E MAIN ST
Practice Address - Street 2:
Practice Address - City:LAMAR
Practice Address - State:AR
Practice Address - Zip Code:72846-7401
Practice Address - Country:US
Practice Address - Phone:479-733-0400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-08
Last Update Date:2019-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR2052-C1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5EC12OtherBCBS
AR14189573OtherCAQH
AR236859719Medicaid