Provider Demographics
NPI:1699902403
Name:CARLAN, JILLIAN (LCSW)
Entity type:Individual
Prefix:
First Name:JILLIAN
Middle Name:
Last Name:CARLAN
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 1:10515 W MARKHAM ST STE B3
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72205-2285
Mailing Address - Country:US
Mailing Address - Phone:501-590-8663
Mailing Address - Fax:
Practice Address - Street 1:10515 W MARKHAM ST STE B3
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205-2285
Practice Address - Country:US
Practice Address - Phone:501-590-8663
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-06-18
Last Update Date:2020-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR6959-C1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
1041C0700XOtherTAXONOMY CODE