Provider Demographics
NPI:1083716732
Name:COTTON, JANNIE MARIE (MS, LPC)
Entity Type:Individual
Prefix:
First Name:JANNIE
Middle Name:MARIE
Last Name:COTTON
Suffix:
Gender:F
Credentials:MS, LPC
Other - Prefix:
Other - First Name:JANNIE
Other - Middle Name:MARIE
Other - Last Name:ISOM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, LPC
Mailing Address - Street 1:PO BOX 15968
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72231-5968
Mailing Address - Country:US
Mailing Address - Phone:501-221-1843
Mailing Address - Fax:501-221-2376
Practice Address - Street 1:3601 RICHARDS ROAD
Practice Address - Street 2:
Practice Address - City:NORTH LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72117
Practice Address - Country:US
Practice Address - Phone:501-221-1843
Practice Address - Fax:501-221-2376
Is Sole Proprietor?:No
Enumeration Date:2006-09-02
Last Update Date:2009-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARP9412031101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional