Healthcare Provider Details

I. General information

NPI: 1699857987
Provider Name (Legal Business Name): VIRGINIA DEARMAN LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/19/2006
Last Update Date: 09/29/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1215 SIDNEY ST
BATESVILLE AR
72501-7203
US

IV. Provider business mailing address

2055 MAPLE ST
BATESVILLE AR
72501-3632
US

V. Phone/Fax

Practice location:
  • Phone: 870-972-1268
  • Fax:
Mailing address:
  • Phone: 662-617-4012
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number2115 - M
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: