| Andrea M. Edgmon, Lcsw, Pllc | |
|
313 S Rogers St Ste C Clarksville AR 72830-3741 | |
| (479) 388-0032 | |
| Not Available |
| Full Name | Andrea M. Edgmon, Lcsw, Pllc |
|---|---|
| Speciality | Social Worker |
| Location | 313 S Rogers St Ste C, Clarksville, Arkansas |
| Authorized Official Name and Position | Andrea Edgmon (PRESIDENT/CLINICAL SOCIAL WORKER) |
| Authorized Official Contact | 4792140456 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Andrea M. Edgmon, Lcsw, Pllc 299 County Road 3299 Clarksville AR 72830-8268 Ph: (479) 214-0456 | Andrea M. Edgmon, Lcsw, Pllc 313 S Rogers St Ste C Clarksville AR 72830-3741 Ph: (479) 388-0032 |
| NPI Number | 1457073801 |
|---|---|
| Provider Enumeration Date | 09/13/2022 |
| Last Update Date | 09/13/2022 |
| Certification Date | 09/08/2022 |
| Medicare PECOS PAC ID | 8426405457 |
|---|---|
| Medicare Enrollment ID | O20231113000797 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1457073801 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
| Provider Name | Andrea Edgmon |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1659753515 PECOS PAC ID: 5698122612 Enrollment ID: I20231114000791 |
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