Healthcare Provider Details

I. General information

NPI: 1982169835
Provider Name (Legal Business Name): CRAIG OLIENYK LAC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/05/2019
Last Update Date: 02/05/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

74 W SUNBRIDGE DR
FAYETTEVILLE AR
72703-1822
US

IV. Provider business mailing address

1600 ALDERSGATE RD STE 200
LITTLE ROCK AR
72205-6676
US

V. Phone/Fax

Practice location:
  • Phone: 479-582-5565
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberA1901011
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: