Healthcare Provider Details

I. General information

NPI: 1629696984
Provider Name (Legal Business Name): HAILEY MARIE WASHAM LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2020
Last Update Date: 05/18/2026
Certification Date: 05/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1090 ARNOLD DR
LITTLE ROCK AFB AR
72099-4933
US

IV. Provider business mailing address

1090 ARNOLD DR
LITTLE ROCK AFB AR
72099-4933
US

V. Phone/Fax

Practice location:
  • Phone: 501-987-7377
  • Fax:
Mailing address:
  • Phone: 501-987-7377
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number9993-C
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: