Provider Demographics
NPI:1386735728
Name:SMITH, VIRGIL RODNEY (LCSW)
Entity type:Individual
Prefix:
First Name:VIRGIL
Middle Name:RODNEY
Last Name:SMITH
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1105 GRAZING LN
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72076-6232
Mailing Address - Country:US
Mailing Address - Phone:501-982-2426
Mailing Address - Fax:
Practice Address - Street 1:1101 W 2ND ST
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72201-2003
Practice Address - Country:US
Practice Address - Phone:501-257-4398
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR948-C1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR948-COtherSOCIAL WORK LICENSE