Healthcare Provider Details

I. General information

NPI: 1083820773
Provider Name (Legal Business Name): GREGORY K. SMITH DSW, LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/16/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20400 COLONEL GLENN RD
LITTLE ROCK AR
72210-5323
US

IV. Provider business mailing address

26 BALD EAGLE DR
PARON AR
72122-8075
US

V. Phone/Fax

Practice location:
  • Phone: 501-821-5500
  • Fax:
Mailing address:
  • Phone: 501-804-7187
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number1574C
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: