| Mike Knickerbocker, LADAC | |
|
412 York St, Warren, AR 71671-3218 | |
| (870) 226-9970 | |
| (870) 226-9972 |
| Full Name | Mike Knickerbocker |
|---|---|
| Gender | Male |
| Speciality | Counselor - Addiction (substance Use Disorder) |
| Location | 412 York St, Warren, Arkansas |
| Accepts Medicare Assignments | Does not participate in Medicare Program. He may not accept medicare assignment. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1770847485 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YA0400X | Counselor - Addiction (substance Use Disorder) | 0159L (Arkansas) | Primary |
| 101YA0400X | Counselor - Addiction (substance Use Disorder) | A-194 (Arkansas) | Secondary |
| Mailing Address | Practice Location Address |
|---|---|
| Mike Knickerbocker, LADAC 412 York St, Warren, AR 71671-3218 Ph: (870) 226-9970 | Mike Knickerbocker, LADAC 412 York St, Warren, AR 71671-3218 Ph: (870) 226-9970 |
Shelly Wolfe, LPC Counselor Medicare: Medicare Enrolled Practice Location: 800 N Walnut St, Warren, AR 71671 Phone: 870-226-6754 Fax: 870-226-7925 | |
Andrew Turner, Counselor Medicare: Not Enrolled in Medicare Practice Location: 412 York St, Warren, AR 71671 Phone: 870-226-9970 | |
Stephanie M Harper, LAC Counselor Medicare: Medicare Enrolled Practice Location: 1404 East Church Street, Warren, AR 71671 Phone: 870-226-5856 Fax: 870-226-6208 | |
Mrs. Latasha Rochell, Counselor Medicare: Not Enrolled in Medicare Practice Location: 412 York St, Warren, AR 71671 Phone: 870-226-9970 |