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General NPI Number Information
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NPI Number | 1407283039
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Entity Type | Individual
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Provider Name | DANA C GULLETT LCSW
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Gender | Female
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Dates
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Enumeration Date | 09/27/2013
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Last Update Date | 03/17/2018
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Provider Practice Location Address
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Address Line | 2200 FORT ROOTS DR
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City | NORTH LITTLE ROCK
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State | AR
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Zip | 72114-1709
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Country | US
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Telephone | 501-257-3357
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 15968
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City | LITTLE ROCK
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State | AR
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Zip | 72231-5968
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Country | US
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Telephone | 501-221-1843
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Fax | 501-221-2376
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | 6518-M
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License Number State | AR
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 6518-C
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License Number State | AR
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