Provider Demographics
NPI:1073848826
Name:WILLITS, MALTA CAROL (MHPP)
Entity Type:Individual
Prefix:MS
First Name:MALTA
Middle Name:CAROL
Last Name:WILLITS
Suffix:
Gender:F
Credentials:MHPP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11321 INTERSTATE 30 STE 104
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72209-7064
Mailing Address - Country:US
Mailing Address - Phone:501-202-7587
Mailing Address - Fax:501-202-6683
Practice Address - Street 1:11321 INTERSTATE 30 STE 104
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72209-7064
Practice Address - Country:US
Practice Address - Phone:501-202-7587
Practice Address - Fax:501-202-6683
Is Sole Proprietor?:No
Enumeration Date:2009-10-13
Last Update Date:2009-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator