Healthcare Provider Details

I. General information

NPI: 1205112182
Provider Name (Legal Business Name): WILLIAM SWEETWOOD LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/24/2011
Last Update Date: 01/18/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 N ROCKINGCHAIR RD STE 1-3
PARAGOULD AR
72450-2413
US

IV. Provider business mailing address

100 N ROCKINGCHAIR RD STE 1-3
PARAGOULD AR
72450-2413
US

V. Phone/Fax

Practice location:
  • Phone: 870-335-9617
  • Fax: 870-335-9618
Mailing address:
  • Phone: 870-335-9617
  • Fax: 870-335-9618

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberA0809060
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: