Healthcare Provider Details

I. General information

NPI: 1316608383
Provider Name (Legal Business Name): RUSSELL DURDUNJI LMFT, MBA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/03/2022
Last Update Date: 06/16/2026
Certification Date: 06/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12 HERITAGE CT
LITTLE ROCK AR
72211-1601
US

IV. Provider business mailing address

12 HERITAGE CT
LITTLE ROCK AR
72211-1601
US

V. Phone/Fax

Practice location:
  • Phone: 256-335-3714
  • Fax:
Mailing address:
  • Phone: 256-335-3714
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberM2407001
License Number StateAR
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number1784
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: