=====================================================
General NPI Number Information
=====================================================
NPI Number | 1669499240
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ERIN E DENTON LCSW, LADAC, EMDR
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/17/2006
-----------------------------------------------------
Last Update Date | 12/12/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2909 KING ST JONESBORO SUITE A
-----------------------------------------------------
City | JONESBORO
-----------------------------------------------------
State | AR
-----------------------------------------------------
Zip | 72401-7870
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 870-933-6886
-----------------------------------------------------
Fax | 870-933-9395
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2909 KING ST STE A
-----------------------------------------------------
City | JONESBORO
-----------------------------------------------------
State | AR
-----------------------------------------------------
Zip | 72401-5326
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 870-351-9860
-----------------------------------------------------
Fax | 870-382-3025
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | 2032-C
-----------------------------------------------------
License Number State | AR
-----------------------------------------------------