Healthcare Provider Details

I. General information

NPI: 1689815433
Provider Name (Legal Business Name): WILLIAM MARK SMITH LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/07/2009
Last Update Date: 03/07/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

615 E MATTHEWS AVE STE A
JONESBORO AR
72401-3106
US

IV. Provider business mailing address

615 E MATTHEWS AVE STE A
JONESBORO AR
72401-3106
US

V. Phone/Fax

Practice location:
  • Phone: 870-930-9090
  • Fax:
Mailing address:
  • Phone: 870-930-9090
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number758-C
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: