Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1041C0700X | Clinical Social Worker | 7653-C | AR |
NPI | 1003232141 |
---|---|
Provider Name | Stephen Peairson JR. |
First Address | Benton, AR 72015-4436 |
Second Address | Benton, AR 72015 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/03/2014 |
Last Update Date | 06/11/2018 |