Basic Information
| Provider Information | |||||||||
| NPI: | 1124378039 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ADKINS | ||||||||
| FirstName: | SAMUEL | ||||||||
| MiddleName: | EDWARD | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | LMSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7107 W 12TH ST | ||||||||
| Address2: | SUITE 201 | ||||||||
| City: | LITTLE ROCK | ||||||||
| State: | AR | ||||||||
| PostalCode: | 722042404 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5016631837 | ||||||||
| FaxNumber: | 5016631839 | ||||||||
| Practice Location | |||||||||
| Address1: | 9914 I-30 FRONTAGE ROAD | ||||||||
| Address2: | |||||||||
| City: | LITTLE ROCK | ||||||||
| State: | AR | ||||||||
| PostalCode: | 72209 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5012650302 | ||||||||
| FaxNumber: | 5012650300 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/18/2012 | ||||||||
| LastUpdateDate: | 09/25/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101Y00000X | 6401-M | AR | N | Behavioral Health & Social Service Providers | Counselor | 104100000X | 6401-M | AR | Y | Behavioral Health & Social Service Providers | Social Worker |
No ID Information.