Provider Demographics
NPI:1124074802
Name:WEAVER, BARBARA A (LCSW)
Entity type:Individual
Prefix:
First Name:BARBARA
Middle Name:A
Last Name:WEAVER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 717
Mailing Address - Street 2:
Mailing Address - City:MANILA
Mailing Address - State:AR
Mailing Address - Zip Code:72442-0717
Mailing Address - Country:US
Mailing Address - Phone:870-570-0358
Mailing Address - Fax:
Practice Address - Street 1:920 MEDICAL DR
Practice Address - Street 2:
Practice Address - City:MANILA
Practice Address - State:AR
Practice Address - Zip Code:72442-8416
Practice Address - Country:US
Practice Address - Phone:870-570-0358
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-25
Last Update Date:2022-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR1313-C1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5W322OtherBLUECROSS BLIESHIELD
AR5W322OtherBLUECROSS BLIESHIELD