Healthcare Provider Details

I. General information

NPI: 1366950958
Provider Name (Legal Business Name): CONNECTIONS COUNSELING CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/17/2018
Last Update Date: 07/15/2024
Certification Date: 07/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2510 CRESCENT DR
HORSESHOE BEND AR
72512-5576
US

IV. Provider business mailing address

2510 CRESCENT DR
HORSESHOE BEND AR
72512-5576
US

V. Phone/Fax

Practice location:
  • Phone: 870-351-6100
  • Fax: 870-750-2199
Mailing address:
  • Phone: 870-351-6100
  • Fax: 870-750-2199

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberP1109069
License Number StateAR
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: VICKI D MARTIN
Title or Position: SOLE PROPRIETOR
Credential: LPC
Phone: 870-351-6100