Provider Demographics
NPI:1871695742
Name:DEACON, CASEY MICHELLE (LCSW)
Entity type:Individual
Prefix:MRS
First Name:CASEY
Middle Name:MICHELLE
Last Name:DEACON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:CASEY
Other - Middle Name:MICHELLE
Other - Last Name:GILBERT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:1231 EAST SOUTHERN HEIGHTS
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72701
Mailing Address - Country:US
Mailing Address - Phone:479-387-4535
Mailing Address - Fax:
Practice Address - Street 1:1231 EAST SOUTHERN HEIGHTS
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:AR
Practice Address - Zip Code:72701
Practice Address - Country:US
Practice Address - Phone:479-387-4535
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-02
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR1975-C1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5Y807OtherAR BLUE CROSS #