Provider Demographics
NPI:1447473517
Name:SPANN, NITA M (LCSW)
Entity type:Individual
Prefix:MS
First Name:NITA
Middle Name:M
Last Name:SPANN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 CORPORATE HILL
Mailing Address - Street 2:STE 330
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72205
Mailing Address - Country:US
Mailing Address - Phone:501-954-7470
Mailing Address - Fax:501-954-7420
Practice Address - Street 1:10 CORPORATE HILL
Practice Address - Street 2:STE 330
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205
Practice Address - Country:US
Practice Address - Phone:501-954-7470
Practice Address - Fax:501-954-7420
Is Sole Proprietor?:No
Enumeration Date:2007-04-10
Last Update Date:2011-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARC7031041C0700X
ARC-7031041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR137548726Medicaid