Provider Demographics
NPI:1508970328
Name:WESLEY, JOYCE S (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:JOYCE
Middle Name:S
Last Name:WESLEY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:JOYCE
Other - Middle Name:S
Other - Last Name:WALKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:11523 KANIS RD STE B
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72211-3788
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:11523 KANIS RD STE B
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72211-3788
Practice Address - Country:US
Practice Address - Phone:501-570-6987
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-18
Last Update Date:2023-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR1876-C1041C0700X
171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR159613719Medicaid
AR159613719Medicaid
AR5X847Medicare ID - Type Unspecified