Provider Demographics
NPI:1750520953
Name:SMITH, MARK T
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:T
Last Name:SMITH
Suffix:
Gender:M
Credentials:
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 1400
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72203-1400
Mailing Address - Country:US
Mailing Address - Phone:501-372-5039
Mailing Address - Fax:
Practice Address - Street 1:700 W 4TH ST
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72201-2204
Practice Address - Country:US
Practice Address - Phone:501-372-5039
Practice Address - Fax:501-372-5529
Is Sole Proprietor?:No
Enumeration Date:2009-02-11
Last Update Date:2009-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker