Healthcare Provider Details

I. General information

NPI: 1982826830
Provider Name (Legal Business Name): EMMETT A PRESLEY LCSW, DCSW, MSWAC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/02/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1817 WOODSPRINGS RD STE G
JONESBORO AR
72401-0903
US

IV. Provider business mailing address

PO BOX 32
STATE UNIVERSITY AR
72467-0032
US

V. Phone/Fax

Practice location:
  • Phone: 870-934-9800
  • Fax: 870-934-8463
Mailing address:
  • Phone: 870-935-3625
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberC-218
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: