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1861407520
BENJAMIN L TIDWELL
RIVERVIEW, FL
NPI
1861407520
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
No
Primary Taxonomy
1041C0700X Social Worker, Clinical
(Licence: AR 1283C)
Enumeration Date
2006-07-30
Last Update Date
2021-08-11
Business Address
Mr. BENJAMIN L TIDWELL LCSW, CCDP-Diplomate
5905 US 301 S
RIVERVIEW, FL 33578-3800
Phone number: 866-389-2727
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Mailing Address
Mr. BENJAMIN L TIDWELL LCSW, CCDP-Diplomate
35 GOFF ST
VILONIA, AR 72173-9315
Phone number: 501-580-0116
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