Healthcare Provider Details

I. General information

NPI: 1841899986
Provider Name (Legal Business Name): CYNTHIA HRDLICHKA LPC P2306026
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/20/2020
Last Update Date: 09/19/2023
Certification Date: 09/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

221 N EAST AVE STE 104
FAYETTEVILLE AR
72701-5226
US

IV. Provider business mailing address

608 N ROCKCLIFF RD
FAYETTEVILLE AR
72701-3814
US

V. Phone/Fax

Practice location:
  • Phone: 479-549-7295
  • Fax:
Mailing address:
  • Phone: 501-232-3058
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberP2306026
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: