Provider Demographics
NPI:1134400336
Name:LAW, JOSILYN CAMILLE (PHD)
Entity type:Individual
Prefix:DR
First Name:JOSILYN
Middle Name:CAMILLE
Last Name:LAW
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:JOSILYN
Other - Middle Name:CAMILLE
Other - Last Name:BANKS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD
Mailing Address - Street 1:1090 ARNOLD DRIVE
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72076
Mailing Address - Country:US
Mailing Address - Phone:501-978-7338
Mailing Address - Fax:
Practice Address - Street 1:1090 ARNOLD DRIVE
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:AR
Practice Address - Zip Code:72076
Practice Address - Country:US
Practice Address - Phone:501-978-7338
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-31
Last Update Date:2024-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810006058103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical