Provider Demographics
NPI:1447620844
Name:WATTERS, ELIZABETH EMILY CHUGG (LCSW)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:EMILY CHUGG
Last Name:WATTERS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:ELIZABETH
Other - Middle Name:
Other - Last Name:CHUGG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:3103 ALMA HWY
Mailing Address - Street 2:
Mailing Address - City:VAN BUREN
Mailing Address - State:AR
Mailing Address - Zip Code:72956-5027
Mailing Address - Country:US
Mailing Address - Phone:479-474-4483
Mailing Address - Fax:479-262-5041
Practice Address - Street 1:3103 ALMA HWY
Practice Address - Street 2:
Practice Address - City:VAN BUREN
Practice Address - State:AR
Practice Address - Zip Code:72956-5027
Practice Address - Country:US
Practice Address - Phone:479-474-4483
Practice Address - Fax:479-782-5502
Is Sole Proprietor?:No
Enumeration Date:2015-09-29
Last Update Date:2023-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR7746-C1041C0700X, 104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical