Healthcare Provider Details

I. General information

NPI: 1780433581
Provider Name (Legal Business Name): MACIE FAITH WEBB PLMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/14/2024
Last Update Date: 10/04/2024
Certification Date: 05/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

555 W GAINES STREET
MONTICELLO AR
71655
US

IV. Provider business mailing address

10025 W. MARKHAM STREET STE 210
LITTLE ROCK AR
72205-2178
US

V. Phone/Fax

Practice location:
  • Phone: 870-224-7100
  • Fax: 870-224-0373
Mailing address:
  • Phone: 501-663-5473
  • Fax: 501-801-1816

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberPLMSW
License Number StateAR
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: