Provider Demographics
NPI:1710706544
Name:RARDIN, GISHEERA (LCSW)
Entity type:Individual
Prefix:
First Name:GISHEERA
Middle Name:
Last Name:RARDIN
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 1:510 HAWTHORNE
Mailing Address - Street 2:
Mailing Address - City:BENTON
Mailing Address - State:AR
Mailing Address - Zip Code:72015-4922
Mailing Address - Country:US
Mailing Address - Phone:501-515-2127
Mailing Address - Fax:
Practice Address - Street 1:1920 CONGO RD STE C
Practice Address - Street 2:
Practice Address - City:BENTON
Practice Address - State:AR
Practice Address - Zip Code:72015-2884
Practice Address - Country:US
Practice Address - Phone:501-425-6476
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-08
Last Update Date:2024-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR10534-C1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical