Provider Demographics
NPI:1821053737
Name:WEBB, BEVERLY M (LCSW, LADAC)
Entity Type:Individual
Prefix:MS
First Name:BEVERLY
Middle Name:M
Last Name:WEBB
Suffix:
Gender:F
Credentials:LCSW, LADAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1100 N UNIVERSITY AVE
Mailing Address - Street 2:SUITE 133
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72207-6365
Mailing Address - Country:US
Mailing Address - Phone:501-664-0091
Mailing Address - Fax:501-664-0112
Practice Address - Street 1:1100 N UNIVERSITY AVE
Practice Address - Street 2:SUITE 133
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72207-6365
Practice Address - Country:US
Practice Address - Phone:501-664-0091
Practice Address - Fax:501-664-0112
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-20
Last Update Date:2012-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR1245-C1041C0700X
AR0005L101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR50892000001OtherQUALCHOICE
AR5X351OtherBLUE CROSS/BLUE SHIELD
ARWEBBEVEROtherCORPHEALTH