Provider Demographics
NPI:1972899128
Name:BOHANNON, WILLIAM E (MRC, AADC, CCS, CCDP)
Entity Type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:E
Last Name:BOHANNON
Suffix:
Gender:M
Credentials:MRC, AADC, CCS, CCDP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3204 E MOORE AVE
Mailing Address - Street 2:
Mailing Address - City:SEARCY
Mailing Address - State:AR
Mailing Address - Zip Code:72143-4826
Mailing Address - Country:US
Mailing Address - Phone:501-268-7777
Mailing Address - Fax:501-305-5009
Practice Address - Street 1:3204 E MOORE AVE
Practice Address - Street 2:
Practice Address - City:SEARCY
Practice Address - State:AR
Practice Address - Zip Code:72143-4826
Practice Address - Country:US
Practice Address - Phone:501-268-7777
Practice Address - Fax:501-305-5009
Is Sole Proprietor?:No
Enumeration Date:2011-06-27
Last Update Date:2011-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA-018101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)