Healthcare Provider Details

I. General information

NPI: 1124378039
Provider Name (Legal Business Name): SAMUEL EDWARD ADKINS LMSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/18/2012
Last Update Date: 09/25/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9914 I-30 FRONTAGE ROAD
LITTLE ROCK AR
72209
US

IV. Provider business mailing address

7107 W 12TH ST SUITE 201
LITTLE ROCK AR
72204-2404
US

V. Phone/Fax

Practice location:
  • Phone: 501-265-0302
  • Fax: 501-265-0300
Mailing address:
  • Phone: 501-663-1837
  • Fax: 501-663-1839

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number6401-M
License Number StateAR
# 2
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number6401-M
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: