Provider Demographics
NPI:1194241463
Name:WENDY NEWSAM PLLC
Entity type:Organization
Organization Name:WENDY NEWSAM PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:COUNSELOR
Authorized Official - Prefix:MS
Authorized Official - First Name:WENDY
Authorized Official - Middle Name:DAWN
Authorized Official - Last Name:NEWSAM
Authorized Official - Suffix:
Authorized Official - Credentials:MS, LPE-I
Authorized Official - Phone:501-228-5506
Mailing Address - Street 1:10 FAIR OAKS DRIVE
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72204
Mailing Address - Country:US
Mailing Address - Phone:501-240-9574
Mailing Address - Fax:
Practice Address - Street 1:1 INNWOOD CIRCLE
Practice Address - Street 2:SUITE 107
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72211
Practice Address - Country:US
Practice Address - Phone:501-228-5506
Practice Address - Fax:501-228-5506
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-18
Last Update Date:2017-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR13-26EI101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR1184928301OtherWE DO NOT TAKE MEDICARE