Basic Information
| Provider Information | |||||||||
| NPI: | 1487800082 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BRAXTON | ||||||||
| FirstName: | JAMESHIA | ||||||||
| MiddleName: | A | ||||||||
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| Credential: | LCSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1405 N PIERCE ST | ||||||||
| Address2: | STE 101 | ||||||||
| City: | LITTLE ROCK | ||||||||
| State: | AR | ||||||||
| PostalCode: | 722075349 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5016032147 | ||||||||
| FaxNumber: | 5016030324 | ||||||||
| Practice Location | |||||||||
| Address1: | 1405 N PIERCE ST | ||||||||
| Address2: | STE 101 | ||||||||
| City: | LITTLE ROCK | ||||||||
| State: | AR | ||||||||
| PostalCode: | 722075349 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5016032147 | ||||||||
| FaxNumber: | 5016030324 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/14/2008 | ||||||||
| LastUpdateDate: | 12/18/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 2590-C | AR | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.