Provider Demographics
NPI:1790366623
Name:HEACOCK, JULIE (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:JULIE
Middle Name:
Last Name:HEACOCK
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MRS
Other - First Name:JULIE
Other - Middle Name:ANN
Other - Last Name:HEACOCK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:JULIE BROWN
Mailing Address - Street 1:4300 W 7TH ST
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72205-5446
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4300 W 7TH ST
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205-5446
Practice Address - Country:US
Practice Address - Phone:501-257-1000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-21
Last Update Date:2023-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR8813-M1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NONEOtherN/A