Healthcare Provider Details

I. General information

NPI: 1073076733
Provider Name (Legal Business Name): DJS MENTAL HEALTH SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/10/2019
Last Update Date: 05/23/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1401 S ELM ST
LITTLE ROCK AR
72204-3063
US

IV. Provider business mailing address

1401 S ELM ST
LITTLE ROCK AR
72204-3063
US

V. Phone/Fax

Practice location:
  • Phone: 501-535-0858
  • Fax:
Mailing address:
  • Phone: 501-535-0858
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: MS. DENISE JARRETT
Title or Position: SOCIAL WORKER
Credential: LCSW
Phone: 501-626-0858