Provider Demographics
NPI:1093196313
Name:BALENTINE, REED (LCSW)
Entity Type:Individual
Prefix:
First Name:REED
Middle Name:
Last Name:BALENTINE
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 1:115 STEVEN DR
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72205-2149
Mailing Address - Country:US
Mailing Address - Phone:501-594-3656
Mailing Address - Fax:501-300-8412
Practice Address - Street 1:3805 MCCAIN PARK DR STE 112
Practice Address - Street 2:
Practice Address - City:NORTH LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72116-7813
Practice Address - Country:US
Practice Address - Phone:501-594-3656
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-11
Last Update Date:2020-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR7579-C1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical