Provider Demographics
NPI:1073702353
Name:PERRY, CHRISTOPHER M (LCSW)
Entity Type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:M
Last Name:PERRY
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10810 EXECUTIVE CENTER DR
Mailing Address - Street 2:SUITE 303
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72211-4354
Mailing Address - Country:US
Mailing Address - Phone:501-312-7578
Mailing Address - Fax:
Practice Address - Street 1:10810 EXECUTIVE CENTER DR
Practice Address - Street 2:SUITE 303
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72211-4354
Practice Address - Country:US
Practice Address - Phone:501-312-7578
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-10-23
Last Update Date:2007-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR2012-C1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR2012-COtherAR LCSW LICENSE NUMBER