Individual
MR. BENJAMIN L TIDWELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LCSW, CCDP-DIPLOMATE
Contact information
Practice address
5905 US 301 S, RIVERVIEW, FL 33578-3800
(866) 389-2727
Mailing address
35 GOFF ST, VILONIA, AR 72173-9315
(501) 580-0116
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
1283C
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
175962795
—
AR
Enumeration date
07/30/2006
Last updated
08/11/2021
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