Healthcare Provider Details

I. General information

NPI: 1497466247
Provider Name (Legal Business Name): ANNA JOHNSON LAC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ANNA SAMS

II. Dates (important events)

Enumeration Date: 12/12/2022
Last Update Date: 10/06/2026
Certification Date: 10/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8 WILSON FARM RD STE D
GREENBRIER AR
72058-8200
US

IV. Provider business mailing address

8 WILSON FARM RD STE D
GREENBRIER AR
72058-8200
US

V. Phone/Fax

Practice location:
  • Phone: 501-557-6785
  • Fax: 501-613-0411
Mailing address:
  • Phone: 501-557-6785
  • Fax: 501-613-0411

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberP2609033
License Number StateAR
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberF2302001
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: