Provider Demographics
NPI:1578945499
Name:PATRICK, JANICA HUMPHREY (LCSW)
Entity type:Individual
Prefix:
First Name:JANICA
Middle Name:HUMPHREY
Last Name:PATRICK
Suffix:
Gender:
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4513 SUMMIT RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:AR
Mailing Address - Zip Code:72404-9103
Mailing Address - Country:US
Mailing Address - Phone:731-413-4196
Mailing Address - Fax:
Practice Address - Street 1:4513 SUMMIT RIDGE DR
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:AR
Practice Address - Zip Code:72404-9103
Practice Address - Country:US
Practice Address - Phone:731-413-4196
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-27
Last Update Date:2025-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health