Provider Demographics
NPI:1720193055
Name:DEATON, DONALD G (MSSW, LCSW)
Entity Type:Individual
Prefix:MR
First Name:DONALD
Middle Name:G
Last Name:DEATON
Suffix:
Gender:M
Credentials:MSSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2200 FORT ROOTS DRIVE
Mailing Address - Street 2:MENTAL HEALTH
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72114-1706
Mailing Address - Country:US
Mailing Address - Phone:501-257-3312
Mailing Address - Fax:501-257-3109
Practice Address - Street 1:2200 FORT ROOTS DR
Practice Address - Street 2:MENTAL HEALTH
Practice Address - City:NORTH LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72114-1709
Practice Address - Country:US
Practice Address - Phone:501-257-3312
Practice Address - Fax:501-257-3109
Is Sole Proprietor?:No
Enumeration Date:2006-08-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA45701041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA4570OtherLCSW