Healthcare Provider Details

I. General information

NPI: 1104882547
Provider Name (Legal Business Name): NORTHWEST COUNSELING & SOCIAL WORK SERVICES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/25/2006
Last Update Date: 08/06/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 E DAVIDSON ST
FAYETTEVILLE AR
72701-3413
US

IV. Provider business mailing address

PO BOX 264
FAYETTEVILLE AR
72702-0264
US

V. Phone/Fax

Practice location:
  • Phone: 479-973-9790
  • Fax: 479-973-9790
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License NumberP931103
License Number StateAR

VIII. Authorized Official

Name: MRS. CATHERINE A TOTTEN
Title or Position: OWNER/THERAPIST
Credential: LCSW
Phone: 479-973-9790