Provider Demographics
NPI:1952508988
Name:WOODING, JIMMIE ANNETTE (LCSW)
Entity Type:Individual
Prefix:
First Name:JIMMIE
Middle Name:ANNETTE
Last Name:WOODING
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:JIMMIE
Other - Middle Name:ANNETTE
Other - Last Name:BOWEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:615 N 19TH ST
Mailing Address - Street 2:
Mailing Address - City:FORT SMITH
Mailing Address - State:AR
Mailing Address - Zip Code:72901-3319
Mailing Address - Country:US
Mailing Address - Phone:479-785-4083
Mailing Address - Fax:479-668-2059
Practice Address - Street 1:615 N 19TH ST
Practice Address - Street 2:
Practice Address - City:FORT SMITH
Practice Address - State:AR
Practice Address - Zip Code:72901-3319
Practice Address - Country:US
Practice Address - Phone:479-785-4083
Practice Address - Fax:479-668-2059
Is Sole Proprietor?:No
Enumeration Date:2007-07-02
Last Update Date:2013-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR2387-C1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical