Provider Demographics
NPI:1851428742
Name:RUSSELL, JILLIAN (LCSW)
Entity type:Individual
Prefix:
First Name:JILLIAN
Middle Name:
Last Name:RUSSELL
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 1:300 S RODNEY PARHAM RD STE 12
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72205-4774
Mailing Address - Country:US
Mailing Address - Phone:501-575-2344
Mailing Address - Fax:
Practice Address - Street 1:300 S RODNEY PARHAM RD STE 12
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205-4774
Practice Address - Country:US
Practice Address - Phone:501-575-2344
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-27
Last Update Date:2024-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR8808-C1041C0700X, 1041C0700X
AR8808-M104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker