Healthcare Provider Details

I. General information

NPI: 1124283619
Provider Name (Legal Business Name): DAWNEACE TAYLOR LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/23/2008
Last Update Date: 08/09/2021
Certification Date: 08/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 HARRISON ST RM 101
BATESVILLE AR
72501-6906
US

IV. Provider business mailing address

226 MOCKINGBIRD ST APT 1
BATESVILLE AR
72501-6604
US

V. Phone/Fax

Practice location:
  • Phone: 870-291-3707
  • Fax:
Mailing address:
  • Phone: 870-291-3707
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number7996-C
License Number StateAR
# 2
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number7996-M
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: