MIKE KNICKERBOCKER LADAC NPI 1770847485

NPI Information

NPI: 1770847485
Provider Name: MIKE KNICKERBOCKER, LADAC
Classification: Counselor - 101YA0400X
Entity Type: Individual

Specialization: Addiction (Substance Use Disorder)

Address:
412 YORK ST
WARREN, AR
ZIP 71671
Phone: (870) 226-9970
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Mike Knickerbocker, LADAC is an addiction (substance use disorder) counselor in Warren, AR. Mike Knickerbocker, LADAC NPI is 1770847485. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

The provider's business location address is:

412 YORK ST
WARREN, AR
ZIP 71671-218
Phone: (870) 226-9970
Fax: (870) 226-9972

The enumeration date for this NPI number is 6/27/2012 and was last updated on 6/27/2012.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	101YA0400X	Counselor	Addiction (Substance Use Disorder)	A-194	ARKANSAS	No
2	101YA0400X	Counselor	Addiction (Substance Use Disorder)	0159L	ARKANSAS	Yes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

NPI Synchronization or Removal

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