Provider Demographics
NPI:1164631750
Name:FULLER, WILLIAM S (LCSW)
Entity Type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:S
Last Name:FULLER
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 1:1501 N PIERCE ST
Mailing Address - Street 2:SUITE 105
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72207-5203
Mailing Address - Country:US
Mailing Address - Phone:501-664-4301
Mailing Address - Fax:501-664-4301
Practice Address - Street 1:1501 N PIERCE ST
Practice Address - Street 2:SUITE 105
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72207-5203
Practice Address - Country:US
Practice Address - Phone:501-664-4301
Practice Address - Fax:501-664-4301
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR1094-C1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical