Individual
MS. ALLISON ELIZABETH FULLEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
2411 W MAIN ST, JACKSONVILLE, AR 72076-4211
(501) 982-5402
(501) 982-5404
Mailing address
2411 W MAIN ST, JACKSONVILLE, AR 72076-4211
(501) 982-5402
(501) 982-5404
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
2221M
AR
1041C0700X
Clinical Social Worker
Primary
2558-C
AR
171M00000X
Case Manager/Care Coordinator
—
—
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
150200726
—
AR
Enumeration date
07/11/2007
Last updated
02/03/2022
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