Provider Demographics
NPI:1033218789
Name:FUDOLI, JAMES V (MS)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:V
Last Name:FUDOLI
Suffix:
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:350 SALEM ROAD
Mailing Address - Street 2:SUITE 1
Mailing Address - City:CONWAY
Mailing Address - State:AR
Mailing Address - Zip Code:72034
Mailing Address - Country:US
Mailing Address - Phone:501-336-8300
Mailing Address - Fax:501-329-3572
Practice Address - Street 1:350 SALEM ROAD
Practice Address - Street 2:SUITE 1
Practice Address - City:CONWAY
Practice Address - State:AR
Practice Address - Zip Code:72034
Practice Address - Country:US
Practice Address - Phone:501-336-8300
Practice Address - Fax:501-329-3572
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARP0501004101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health