Healthcare Provider Details

I. General information

NPI: 1518244987
Provider Name (Legal Business Name): CHERYL JEAN JENKINS-AKERS LAADAC, CCDP, MHPP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/13/2011
Last Update Date: 11/13/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1004 S MAIN ST
BERRYVILLE AR
72616-4330
US

IV. Provider business mailing address

1004 S MAIN ST
BERRYVILLE AR
72616-4330
US

V. Phone/Fax

Practice location:
  • Phone: 870-423-1077
  • Fax: 870-741-4088
Mailing address:
  • Phone: 870-423-1077
  • Fax: 870-741-4088

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number0313AL
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: