Provider Demographics
NPI:1770714529
Name:STULL, DANICA
Entity type:Individual
Prefix:
First Name:DANICA
Middle Name:
Last Name:STULL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:DANICA
Other - Middle Name:
Other - Last Name:WIDDICOMBE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1005 BALCOM LN
Mailing Address - Street 2:
Mailing Address - City:TRUMANN
Mailing Address - State:AR
Mailing Address - Zip Code:72472-9502
Mailing Address - Country:US
Mailing Address - Phone:870-483-1461
Mailing Address - Fax:870-483-6520
Practice Address - Street 1:1005 BALCOM LN
Practice Address - Street 2:
Practice Address - City:TRUMANN
Practice Address - State:AR
Practice Address - Zip Code:72472-9502
Practice Address - Country:US
Practice Address - Phone:870-483-1461
Practice Address - Fax:870-483-6520
Is Sole Proprietor?:No
Enumeration Date:2009-07-28
Last Update Date:2012-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker