Provider Demographics
NPI:1184928301
Name:NEWSAM, WENDY (LPE)
Entity type:Individual
Prefix:MS
First Name:WENDY
Middle Name:
Last Name:NEWSAM
Suffix:
Gender:F
Credentials:LPE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 INNWOOD CIR
Mailing Address - Street 2:SUITE 107
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72211-2447
Mailing Address - Country:US
Mailing Address - Phone:501-228-5506
Mailing Address - Fax:
Practice Address - Street 1:1 INNWOOD CIR
Practice Address - Street 2:SUITE 107
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72211-2447
Practice Address - Country:US
Practice Address - Phone:501-228-5506
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-03
Last Update Date:2014-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR13-26E101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor