Healthcare Provider Details

I. General information

NPI: 1467972976
Provider Name (Legal Business Name): JESSICA VILLEGAS LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JESSICA RIVERA LMSW

II. Dates (important events)

Enumeration Date: 06/26/2017
Last Update Date: 06/10/2024
Certification Date: 06/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6601 WEST 12TH STREET
LITTLE ROCK AR
72204-1513
US

IV. Provider business mailing address

P O BOX 251970
LITTLE ROCK AR
72225-1970
US

V. Phone/Fax

Practice location:
  • Phone: 501-666-8686
  • Fax: 501-660-6829
Mailing address:
  • Phone: 501-666-8686
  • Fax: 501-660-6830

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number8321-C
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: