Provider Demographics
NPI:1194574756
Name:DEDRICK, BETSY A (LPC, LMFT)
Entity type:Individual
Prefix:MRS
First Name:BETSY
Middle Name:A
Last Name:DEDRICK
Suffix:
Gender:F
Credentials:LPC, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5507 RANCH DR STE 202
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72223-0043
Mailing Address - Country:US
Mailing Address - Phone:501-258-0050
Mailing Address - Fax:
Practice Address - Street 1:5507 RANCH DR STE 202
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72223-0043
Practice Address - Country:US
Practice Address - Phone:501-258-0050
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-16
Last Update Date:2025-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA2007091101YM0800X
ARF2007007106H00000X
ARM24110001106H00000X
ARP24110001101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist