Healthcare Provider Details

I. General information

NPI: 1376971267
Provider Name (Legal Business Name): GANIECE DUHAIME LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/31/2013
Last Update Date: 07/30/2026
Certification Date: 07/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3214 NW AVIGNON WAY STE 4
BENTONVILLE AR
72712-4192
US

IV. Provider business mailing address

10 SENNEN LN
BELLA VISTA AR
72714-1731
US

V. Phone/Fax

Practice location:
  • Phone: 801-200-1945
  • Fax:
Mailing address:
  • Phone: 801-200-1945
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number87880036004
License Number StateUT
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberCCMH0208391
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: