Healthcare Provider Details

I. General information

NPI: 1518444843
Provider Name (Legal Business Name): FACE2FACE THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/19/2018
Last Update Date: 03/05/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

603 HARKRIDER ST
CONWAY AR
72032-5633
US

IV. Provider business mailing address

603 HARKRIDER ST
CONWAY AR
72032-5633
US

V. Phone/Fax

Practice location:
  • Phone: 501-514-0417
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number8136-C
License Number StateAR

VIII. Authorized Official

Name: ANGELA CAMPAGNA
Title or Position: OWNER/MANAGER
Credential: LCSW
Phone: 501-514-0417