Healthcare Provider Details

I. General information

NPI: 1104217611
Provider Name (Legal Business Name): DAWSON J WILLIAMS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/05/2015
Last Update Date: 02/05/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4700 W COMMERCIAL DR STE B1
NORTH LITTLE ROCK AR
72116-8089
US

IV. Provider business mailing address

112 FAIR OAKS DR
JACKSONVILLE AR
72076-4280
US

V. Phone/Fax

Practice location:
  • Phone: 501-837-9723
  • Fax:
Mailing address:
  • Phone: 501-837-9723
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License NumberF1501002
License Number StateAR

VIII. Authorized Official

Name: DAWSON WILLIAMS
Title or Position: THERAPIST
Credential: LAMFT
Phone: 501-837-9723