Healthcare Provider Details

I. General information

NPI: 1568081388
Provider Name (Legal Business Name): SEAN'S CRISIS CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/11/2020
Last Update Date: 04/11/2020
Certification Date: 04/11/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3305 MALLOY ST
LITTLE ROCK AR
72204-4480
US

IV. Provider business mailing address

3305 MALLOY ST
LITTLE ROCK AR
72204-4480
US

V. Phone/Fax

Practice location:
  • Phone: 501-412-5520
  • Fax:
Mailing address:
  • Phone: 501-412-5520
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: SEAN DAVIDSON
Title or Position: CEO
Credential: M.D
Phone: 501-412-5520