Healthcare Provider Details

I. General information

NPI: 1295732162
Provider Name (Legal Business Name): LINDA B CLEMENT LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/06/2005
Last Update Date: 12/19/2008
Certification Date:
Deactivation Date: 03/20/2006
Reactivation Date: 04/03/2006

III. Provider practice location address

415 N MCKINLEY ST SUITE 430
LITTLE ROCK AR
72205-3013
US

IV. Provider business mailing address

415 N MCKINLEY ST SUITE 430
LITTLE ROCK AR
72205-3013
US

V. Phone/Fax

Practice location:
  • Phone: 501-663-4331
  • Fax: 501-663-1335
Mailing address:
  • Phone: 501-663-4331
  • Fax: 501-663-1335

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number1008C
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: