Provider Demographics
NPI:1548348832
Name:CARDEN, TRACY ANN (LCSW)
Entity type:Individual
Prefix:MISS
First Name:TRACY
Middle Name:ANN
Last Name:CARDEN
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 1:1217 STONE ST.
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:AR
Mailing Address - Zip Code:72401
Mailing Address - Country:US
Mailing Address - Phone:870-972-1268
Mailing Address - Fax:870-934-0847
Practice Address - Street 1:1487 W. KEISER AVENUE
Practice Address - Street 2:SUITE 1
Practice Address - City:OSCEOLA
Practice Address - State:AK
Practice Address - Zip Code:72370
Practice Address - Country:US
Practice Address - Phone:870-563-4500
Practice Address - Fax:870-563-4501
Is Sole Proprietor?:No
Enumeration Date:2006-11-02
Last Update Date:2012-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR1719-M101YM0800X
AR2099-C1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health