Provider Demographics
NPI:1750351045
Name:WEAVER, NANCY B (LCSW)
Entity type:Individual
Prefix:MS
First Name:NANCY
Middle Name:B
Last Name:WEAVER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 6399
Mailing Address - Street 2:
Mailing Address - City:HOT SPRINGS
Mailing Address - State:AR
Mailing Address - Zip Code:71902-6399
Mailing Address - Country:US
Mailing Address - Phone:501-624-7111
Mailing Address - Fax:501-623-5510
Practice Address - Street 1:505 W GRAND AVE
Practice Address - Street 2:
Practice Address - City:HOT SPRINGS
Practice Address - State:AR
Practice Address - Zip Code:71901-3931
Practice Address - Country:US
Practice Address - Phone:501-624-7111
Practice Address - Fax:501-623-5510
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR1782-C104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5X299Medicare ID - Type Unspecified