NPIMap

Organization Active NPI

Im a 10 Wellness Center, LLC

  • Clinical Social Worker
  • Searcy, AR
National Provider Identifier
1982141149
Registry record updated Jun 16, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
5940-C Issued in AR
Legal business name
IM A 10 WELLNESS CENTER, LLC
Practice address
404 Lake Wood Dr
Searcy, AR 72143-9056
Phone
(501) 593-6997
Fax
(501) 325-2912
NPI assigned
Jan 26, 2017
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 16, 2018

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

Authorized official

Name
Shivonne Marie McCarroll
Title
Office Manager
Phone
(501) 593-6997

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social WorkerGroup: 193400000X SINGLE SPECIALTY GROUP 1041C0700X 5940-C AR Primary

Addresses

Primary practice location

404 Lake Wood Dr
Searcy, AR 72143-9056

Mailing address

404 Lake Wood Dr
Searcy, AR 72143-9056
Phone (501) 593-6997

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1485388800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1529107200000",
    "number": "1982141149",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "404 LAKE WOOD DR",
            "city": "SEARCY",
            "state": "AR",
            "postal_code": "721439056",
            "telephone_number": "501-593-6997",
            "fax_number": "501-325-2912"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "404 LAKE WOOD DR",
            "city": "SEARCY",
            "state": "AR",
            "postal_code": "721439056",
            "telephone_number": "501-593-6997",
            "fax_number": "501-325-2912"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "IM A 10 WELLNESS CENTER, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-01-26",
        "last_updated": "2018-06-16",
        "status": "A",
        "authorized_official_last_name": "MCCARROLL",
        "authorized_official_first_name": "SHIVONNE",
        "authorized_official_middle_name": "MARIE",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "501-593-6997"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Social Worker, Clinical",
            "state": "AR",
            "license": "5940-C",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Searcy, AR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 16, 2018; 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.