Healthcare Provider Details

I. General information

NPI: 1164068961
Provider Name (Legal Business Name): VANESSA PERDUE BRILL LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/27/2019
Last Update Date: 11/27/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4224 SHUFFIELD DR.
LITTLE ROCK AR
72205-7199
US

IV. Provider business mailing address

25 APRICOT DR
WARD AR
72176-9529
US

V. Phone/Fax

Practice location:
  • Phone: 501-526-8424
  • Fax: 501-526-8499
Mailing address:
  • Phone: 501-773-2035
  • Fax: 501-526-8499

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number8375-M
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: