Provider Demographics
NPI:1740587369
Name:BERRYMAN, DONNA J (LCSW)
Entity Type:Individual
Prefix:
First Name:DONNA
Middle Name:J
Last Name:BERRYMAN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3601 RICHARDS RD
Mailing Address - Street 2:
Mailing Address - City:NORTH LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72117-2954
Mailing Address - Country:US
Mailing Address - Phone:501-221-1843
Mailing Address - Fax:
Practice Address - Street 1:405 N 2ND ST
Practice Address - Street 2:
Practice Address - City:CABOT
Practice Address - State:AR
Practice Address - Zip Code:72023-2539
Practice Address - Country:US
Practice Address - Phone:501-843-3503
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-02-16
Last Update Date:2017-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR6993M104100000X
AR6993-C1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker