Individual
JONATHAN EDWIN WADDELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LCSW
Contact information
Practice address
1210 WOLFE ST, LITTLE ROCK, AR 72202-4618
(501) 364-5150
(501) 364-3966
Mailing address
PO BOX 251418, LITTLE ROCK, AR 72225-1418
(501) 364-1100
(501) 364-4082
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
8906-M
AR
1041C0700X
Clinical Social Worker
Primary
8906-C
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
221648795
—
AR
Enumeration date
07/25/2018
Last updated
06/09/2022
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