Provider Demographics
NPI:1356996540
Name:DAVISON, MARY CATHERINE YATES (LCSW)
Entity type:Individual
Prefix:
First Name:MARY CATHERINE
Middle Name:YATES
Last Name:DAVISON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:CATE
Other - Middle Name:
Other - Last Name:DAVISON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2500 LAKEVIEW RD
Mailing Address - Street 2:
Mailing Address - City:NORTH LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72116-9300
Mailing Address - Country:US
Mailing Address - Phone:501-618-1888
Mailing Address - Fax:
Practice Address - Street 1:2500 LAKEVIEW RD
Practice Address - Street 2:
Practice Address - City:NORTH LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72116-9300
Practice Address - Country:US
Practice Address - Phone:501-618-1888
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-05
Last Update Date:2022-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR9547-M1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical