Provider Demographics
NPI:1154661734
Name:EDMOND, CHAQUITA
Entity type:Individual
Prefix:
First Name:CHAQUITA
Middle Name:
Last Name:EDMOND
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1014 AUTUMN RD
Mailing Address - Street 2:SUITE 4
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72211-3704
Mailing Address - Country:US
Mailing Address - Phone:501-221-1941
Mailing Address - Fax:501-221-1553
Practice Address - Street 1:1014 AUTUMN RD
Practice Address - Street 2:SUITE 4
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72211-3704
Practice Address - Country:US
Practice Address - Phone:501-221-1941
Practice Address - Fax:501-221-1553
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-19
Last Update Date:2013-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker