Healthcare Provider Details

I. General information

NPI: 1508092867
Provider Name (Legal Business Name): ANN T LEACH LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ANN TUCKER DULANEY

II. Dates (important events)

Enumeration Date: 06/01/2009
Last Update Date: 05/03/2022
Certification Date: 05/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

133 HARMONY PARK CIR
HOT SPRINGS AR
71913-5417
US

IV. Provider business mailing address

104 VALLEYVIEW ST
HOT SPRINGS AR
71901-7729
US

V. Phone/Fax

Practice location:
  • Phone: 501-624-7700
  • Fax: 501-623-5788
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number4691-C
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: