Healthcare Provider Details

I. General information

NPI: 1043141278
Provider Name (Legal Business Name): ARKANSAS WELLNESS COUNSELING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/27/2026
Last Update Date: 05/27/2026
Certification Date: 05/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23581 I 30
BRYANT AR
72022-2616
US

IV. Provider business mailing address

6109 GARRISON RD
LITTLE ROCK AR
72223-9763
US

V. Phone/Fax

Practice location:
  • Phone: 501-860-1483
  • Fax:
Mailing address:
  • Phone: 501-860-1483
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: ANDREW ROACH
Title or Position: THERAPIST
Credential: LCSW
Phone: 501-860-1483