Individual
DR. CRAIG JOSEPH PROVOST
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PH.D.
Contact information
Practice address
4300 W 7TH ST, MHSL (116T/LR); CAVHS, LITTLE ROCK, AR 72205-5446
(501) 257-6599
(501) 257-6602
Mailing address
17 SUMMERLAND CT, LITTLE ROCK, AR 72227-3846
(501) 225-5037
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
84-12P
AR
Other
Enumeration date
09/20/2006
Last updated
07/08/2007
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