Provider Demographics
NPI:1083611495
Name:DAMRON, DOUG (MS,LPC)
Entity Type:Individual
Prefix:MR
First Name:DOUG
Middle Name:
Last Name:DAMRON
Suffix:
Gender:M
Credentials:MS,LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1301 WILSON RD
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72205-6659
Mailing Address - Country:US
Mailing Address - Phone:501-225-0576
Mailing Address - Fax:501-225-6789
Practice Address - Street 1:1301 WILSON RD
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205-6659
Practice Address - Country:US
Practice Address - Phone:501-225-0576
Practice Address - Fax:501-225-6789
Is Sole Proprietor?:No
Enumeration Date:2005-06-30
Last Update Date:2007-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARP8903002101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5S305OtherLOCAL BCBS
AR1932174836OtherCLINIC NPI#