Provider Demographics
NPI:1083223010
Name:WEBB, GERALD DWAYNE (LPC)
Entity Type:Individual
Prefix:MR
First Name:GERALD
Middle Name:DWAYNE
Last Name:WEBB
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1305 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:RUSSELLVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72801-5322
Mailing Address - Country:US
Mailing Address - Phone:501-889-4880
Mailing Address - Fax:479-777-9928
Practice Address - Street 1:1305 E MAIN ST
Practice Address - Street 2:
Practice Address - City:RUSSELLVILLE
Practice Address - State:AR
Practice Address - Zip Code:72801-5322
Practice Address - Country:US
Practice Address - Phone:501-889-4880
Practice Address - Fax:479-777-9928
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-27
Last Update Date:2022-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARP2202005101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional