Provider Demographics
NPI:1649421488
Name:BOOTH, D JAMES (LCSW)
Entity Type:Individual
Prefix:
First Name:D
Middle Name:JAMES
Last Name:BOOTH
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:PO BOX 23070
Mailing Address - Street 2:
Mailing Address - City:BARLING
Mailing Address - State:AR
Mailing Address - Zip Code:72923-0070
Mailing Address - Country:US
Mailing Address - Phone:479-452-5040
Mailing Address - Fax:479-452-5047
Practice Address - Street 1:1200 W CENTER ST
Practice Address - Street 2:
Practice Address - City:GREENWOOD
Practice Address - State:AR
Practice Address - Zip Code:72936-3716
Practice Address - Country:US
Practice Address - Phone:479-452-5040
Practice Address - Fax:479-452-5047
Is Sole Proprietor?:No
Enumeration Date:2008-10-09
Last Update Date:2017-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR366-C1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical