Provider Demographics
NPI:1164068961
Name:BRILL, VANESSA PERDUE (LMSW)
Entity Type:Individual
Prefix:
First Name:VANESSA
Middle Name:PERDUE
Last Name:BRILL
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 APRICOT DR
Mailing Address - Street 2:
Mailing Address - City:WARD
Mailing Address - State:AR
Mailing Address - Zip Code:72176-9529
Mailing Address - Country:US
Mailing Address - Phone:501-773-2035
Mailing Address - Fax:501-526-8499
Practice Address - Street 1:4224 SHUFFIELD DR.
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205-7199
Practice Address - Country:US
Practice Address - Phone:501-526-8424
Practice Address - Fax:501-526-8499
Is Sole Proprietor?:No
Enumeration Date:2019-11-27
Last Update Date:2019-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR8375-M104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker