Provider Demographics
NPI:1689815433
Name:SMITH, WILLIAM MARK (LCSW)
Entity Type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:MARK
Last Name:SMITH
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 1:615 E MATTHEWS AVE STE A
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:AR
Mailing Address - Zip Code:72401-3106
Mailing Address - Country:US
Mailing Address - Phone:870-930-9090
Mailing Address - Fax:
Practice Address - Street 1:615 E MATTHEWS AVE STE A
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:AR
Practice Address - Zip Code:72401-3106
Practice Address - Country:US
Practice Address - Phone:870-930-9090
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-07
Last Update Date:2009-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR758-C1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical