Healthcare Provider Details

I. General information

NPI: 1356253892
Provider Name (Legal Business Name): LAURA DICKINSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/21/2026
Last Update Date: 09/21/2026
Certification Date: 09/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7 MEDICAL LN STE H
CONWAY AR
72034-4918
US

IV. Provider business mailing address

2655 COLLINS DR
CONWAY AR
72034-9687
US

V. Phone/Fax

Practice location:
  • Phone: 501-255-3755
  • Fax:
Mailing address:
  • Phone: 816-223-9890
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberP2602006
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: