Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP2500X | Professional Counselor | A1012137 | AR |
NPI | 1003056938 |
---|---|
Provider Name | Charlie Simpson III |
First Address | Little Rock, AR 72225-1703 |
Second Address | Little Rock, AR 72211-1843 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/03/2009 |
Last Update Date | 18/12/2012 |