Healthcare Provider Details

I. General information

NPI: 1639377724
Provider Name (Legal Business Name): LAURA NICOLE WATLINGTON LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/10/2007
Last Update Date: 11/26/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

704 N HUGHES ST
LITTLE ROCK AR
72205-2819
US

IV. Provider business mailing address

704 N HUGHES ST
LITTLE ROCK AR
72205-2819
US

V. Phone/Fax

Practice location:
  • Phone: 501-765-0502
  • Fax:
Mailing address:
  • Phone: 501-765-0502
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number2526-C
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: