| Doctor Name: | JAMES V FUDOLI |
| NPI Number: | 1033218789 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | MS |
| License Number: | P0501004 |
| Business Practice Address: | 350 Salem Road Suite 1 Conway, AR - 72034 |
| Business Phone Number: | 5013368300 |
| Business Fax Number: | 5013293572 |
| Mailing Address: | 350 Salem Road, Suite 1 CONWAY |
| State: | AR |
| Postal Code: | 72034 |
| Phone Number: | 5013368300 |
| Fax Number: | 5013293572 |
| NPI Enumeration Date: | 09/21/2006 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YM0800X |
| License Number: | P0501004 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | AR |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Mental Health |
| Taxonomy Definition: | |