Provider Demographics
NPI:1104150978
Name:MEGGERS, NICOLE DANIELLE (LCSW)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:DANIELLE
Last Name:MEGGERS
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 1:10025 WEST MARKHAM ST
Mailing Address - Street 2:STE. 210
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72205
Mailing Address - Country:US
Mailing Address - Phone:501-663-5473
Mailing Address - Fax:501-801-1816
Practice Address - Street 1:10025 WEST MARKHAM ST
Practice Address - Street 2:STE. 210
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205
Practice Address - Country:US
Practice Address - Phone:501-663-5473
Practice Address - Fax:501-801-1816
Is Sole Proprietor?:No
Enumeration Date:2009-09-28
Last Update Date:2023-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR4943-C1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR228091719Medicaid
AR116399726Medicaid