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04D0858683 CLIA NUMBER - PINE BLUFF CLINIC

Laboratory Demographics

CLIA Number: 04D0858683

Facility Name: PINE BLUFF CLINIC

Facility Address:
1101 TENNESSEE STREET
PINE BLUFF, AR
ZIP 71601
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Facility Phone Number: 870 543-2380

Facility Type: Community Clinic

Certificate Type: Microscopy
NPI Number: 1366955346

Taxonomy: 1041C0700X - Social Worker
A social worker who holds a master's or doctoral degree in social work from an accredited school of social work in addition to at least two years of post-master's supervised experience in a clinical setting. The social worker must be licensed, certified, or registered at the clinical level in the jurisdiction of practice. A clinical social worker provides direct services, including interventions focused on interpersonal interactions, intrapsychic dynamics, and life management issues. Clinical social work services are based on bio-psychosocial perspectives. Services consist of assessment, diagnosis, treatment (including psychotherapy and counseling), client-centered advocacy, consultation, evaluation, and prevention of mental illness, emotional, or behavioral disturbances.

CLIA Record

Field Name Field Value
CLIA Number 04D0858683
LAB Type Community Clinic
Facility Name PINE BLUFF CLINIC
Street 1101 TENNESSEE STREET
City PINE BLUFF
State AR
ZIP 71601
Phone 870 543-2380
CertificateType 3
CertificateEffectiveDate 4/28/2024
CertificateExpirationDate 4/27/2026
FacilityType PPMP

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This page was last updated on: 4/23/2024