Tracy Amanda Waddle, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

2017-C Issued in AR

Practice address

4354 Stockton Dr
North Little Rock, AR 72117-2917

Phone

(501) 955-7600

Fax

(501) 955-7612

NPI assigned

Aug 18, 2006

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Professional Counseling Associates Inc.

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Lonoke, AR
  • NPI 1356965990
  NPD (past)
• Professional Counseling Associates Inc.

  • Community/Behavioral Health Agency
  • North Little Rock, AR
  • NPI 1437164977
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1155859200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1881708600",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "650 S SHACKLEFORD RD",
            "address_2": "SUITE 217",
            "city": "LITTLE ROCK",
            "state": "AR",
            "postal_code": "722113522",
            "telephone_number": "501-221-1843",
            "fax_number": "501-221-2376"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4354 STOCKTON DR",
            "city": "NORTH LITTLE ROCK",
            "state": "AR",
            "postal_code": "721172917",
            "telephone_number": "501-955-7600",
            "fax_number": "501-955-7612"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WADDLE",
        "first_name": "TRACY",
        "middle_name": "AMANDA",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-08-18",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "AR",
            "license": "2017-C",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ARKANSAS BCBS",
            "identifier": "5Y892",
            "state": "AR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Kristen Viverito, PSYD
• Amy Vollman, M.C.D., CCC-SLP
• Brenda Carole Vonohlen
• Lee Ann Voss
• Vinayasrivalli Vunnava
• Lyrayna M Waddy
• Brittany Chasey Wade
• Morgan A Wade
• Kathie Wagner
• Kristen Elise Waldemayer, PH.D.

• Clinical Social Worker in North Little Rock, AR
• Providers in North Little Rock, AR by specialty
• Clinical Social Worker in Arkansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.