Individual
LARRY LUCAS LEWALLEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LCSW
Contact information
Practice address
2701 S CARAWAY RD STE B1, JONESBORO, AR 72401-7336
(870) 926-5710
(870) 933-9395
Mailing address
2701 S CARAWAY RD STE B1, JONESBORO, AR 72401-7336
(870) 926-5710
(870) 933-9395
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
4721-C
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
173598795
—
AR
01
—
5GG69
BCBS
AR
Enumeration date
08/24/2007
Last updated
06/29/2023
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