Healthcare Provider Details

I. General information

NPI: 1275819344
Provider Name (Legal Business Name): VERONICA HAYDON LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: VERONICA ANTHONY

II. Dates (important events)

Enumeration Date: 11/02/2011
Last Update Date: 03/14/2023
Certification Date: 03/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5401 ROGERS AVE STE 200
FORT SMITH AR
72903-3763
US

IV. Provider business mailing address

PO BOX 23070
BARLING AR
72923-0070
US

V. Phone/Fax

Practice location:
  • Phone: 479-226-8403
  • Fax: 479-250-0334
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberP2302011
License Number StateAR
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: