Provider Demographics
NPI:1285754960
Name:MCNUTT, THOMASENA LAMENA (LCSW)
Entity type:Individual
Prefix:MRS
First Name:THOMASENA
Middle Name:LAMENA
Last Name:MCNUTT
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:THOMASENA
Other - Middle Name:LAMENA
Other - Last Name:CRAIG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMSW
Mailing Address - Street 1:4700 W COMMERCIAL DR
Mailing Address - Street 2:SUITE B1
Mailing Address - City:NORTH LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72116-7068
Mailing Address - Country:US
Mailing Address - Phone:501-727-3100
Mailing Address - Fax:501-727-3100
Practice Address - Street 1:4700W COMMERCIAL DR B
Practice Address - Street 2:
Practice Address - City:NORTH LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72116-8089
Practice Address - Country:US
Practice Address - Phone:501-727-3100
Practice Address - Fax:501-727-3100
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-29
Last Update Date:2023-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR2058-C1041C0700X
WALW612214601041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR116378726Medicaid