Provider Demographics
NPI:1679070734
Name:SANSON, WILLIAM ROBERT
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:ROBERT
Last Name:SANSON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2815 RICHMOND RD APT 137
Mailing Address - Street 2:
Mailing Address - City:TEXARKANA
Mailing Address - State:TX
Mailing Address - Zip Code:75503-2174
Mailing Address - Country:US
Mailing Address - Phone:903-277-6965
Mailing Address - Fax:
Practice Address - Street 1:2607 CADDO ST STE 6
Practice Address - Street 2:
Practice Address - City:ARKADELPHIA
Practice Address - State:AR
Practice Address - Zip Code:71923-5307
Practice Address - Country:US
Practice Address - Phone:870-230-8217
Practice Address - Fax:870-230-8201
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-06
Last Update Date:2019-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA1908024101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty