Provider Demographics
NPI:1770800492
Name:SMITH, ROSE (PHD)
Entity type:Individual
Prefix:DR
First Name:ROSE
Middle Name:
Last Name:SMITH
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1220 PINE VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72207-2629
Mailing Address - Country:US
Mailing Address - Phone:501-804-1786
Mailing Address - Fax:
Practice Address - Street 1:2723 FOXCROFT RD
Practice Address - Street 2:SUITE 311A
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72227-2455
Practice Address - Country:US
Practice Address - Phone:501-804-1786
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-21
Last Update Date:2015-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR13-03P103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical