Provider Demographics
NPI:1770320608
Name:J. WADE YOUNGER, LCSW, PLLC
Entity type:Organization
Organization Name:J. WADE YOUNGER, LCSW, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MHP
Authorized Official - Prefix:
Authorized Official - First Name:JUST
Authorized Official - Middle Name:WADE
Authorized Official - Last Name:YOUNGER
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:870-615-0238
Mailing Address - Street 1:5619 C ST
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72205-3313
Mailing Address - Country:US
Mailing Address - Phone:870-615-0238
Mailing Address - Fax:
Practice Address - Street 1:5401 JOHN F KENNEDY BLVD STE G
Practice Address - Street 2:
Practice Address - City:NORTH LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72116-6740
Practice Address - Country:US
Practice Address - Phone:870-615-0238
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-09
Last Update Date:2024-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)