Provider Demographics
NPI:1679356604
Name:GRACIE, CAISA (LMSW)
Entity type:Individual
Prefix:
First Name:CAISA
Middle Name:
Last Name:GRACIE
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:CAISA
Other - Middle Name:
Other - Last Name:DOYLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMSW
Mailing Address - Street 1:PO BOX 9541
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72703-0026
Mailing Address - Country:US
Mailing Address - Phone:479-435-4207
Mailing Address - Fax:479-935-3180
Practice Address - Street 1:3623 JOHNSON MILL BLVD
Practice Address - Street 2:SUITE 103
Practice Address - City:SPRINGDALE
Practice Address - State:AR
Practice Address - Zip Code:72762-6412
Practice Address - Country:US
Practice Address - Phone:479-435-4207
Practice Address - Fax:479-935-3180
Is Sole Proprietor?:No
Enumeration Date:2023-08-15
Last Update Date:2025-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPLMSW104100000X
AR13231-M1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR306257795Medicaid