Healthcare Provider Details

I. General information

NPI: 1407408461
Provider Name (Legal Business Name): EBONY ROBINSON LAC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2019
Last Update Date: 06/18/2026
Certification Date: 06/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

161 SKUNK HOLLOW RD
CONWAY AR
72032-9012
US

IV. Provider business mailing address

161 SKUNK HOLLOW RD
CONWAY AR
72032-9012
US

V. Phone/Fax

Practice location:
  • Phone: 501-666-8686
  • Fax: 501-660-6829
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberP2605024
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: