Healthcare Provider Details

I. General information

NPI: 1447803226
Provider Name (Legal Business Name): DRDHPCCC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/19/2019
Last Update Date: 12/18/2020
Certification Date: 12/18/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 W MAIN ST STE 200
EL DORADO AR
71730-5654
US

IV. Provider business mailing address

101 W MAIN ST STE 200
EL DORADO AR
71730-5654
US

V. Phone/Fax

Practice location:
  • Phone: 870-878-3194
  • Fax:
Mailing address:
  • Phone: 870-878-3194
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name: LARRY C PRESTON
Title or Position: PRESIDENT
Credential:
Phone: 870-725-4700