Basic Information
| Provider Information | |||||||||
| NPI: | 1740331362 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HADDOCK | ||||||||
| FirstName: | DORINDA | ||||||||
| MiddleName: | VALDEZ | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | LCSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 11401 INTERSTATE 30 | ||||||||
| Address2: | |||||||||
| City: | LITTLE ROCK | ||||||||
| State: | AR | ||||||||
| PostalCode: | 722097042 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5012026477 | ||||||||
| FaxNumber: | 5012026475 | ||||||||
| Practice Location | |||||||||
| Address1: | 11401 INTERSTATE 30 | ||||||||
| Address2: | |||||||||
| City: | LITTLE ROCK | ||||||||
| State: | AR | ||||||||
| PostalCode: | 722097042 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5012026477 | ||||||||
| FaxNumber: | 5012026475 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/12/2007 | ||||||||
| LastUpdateDate: | 02/07/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | C-1920 | AR | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.