Healthcare Provider Details

I. General information

NPI: 1114050416
Provider Name (Legal Business Name): FAITH L HANNAH LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/14/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

412 N WASHINGTON AVE
EL DORADO AR
71730-5616
US

IV. Provider business mailing address

900 HANEY AVE
EL DORADO AR
71730-4235
US

V. Phone/Fax

Practice location:
  • Phone: 870-863-4611
  • Fax: 870-863-4962
Mailing address:
  • Phone: 870-500-4656
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number1857-M
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: