Healthcare Provider Details

I. General information

NPI: 1902193337
Provider Name (Legal Business Name): CHRISTA NICOLE LAWRENCE LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CHRISTA N WALTERS

II. Dates (important events)

Enumeration Date: 07/06/2011
Last Update Date: 05/07/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1104 N COLLEGE ST
HUNTSVILLE AR
72740-9672
US

IV. Provider business mailing address

2400 S 48TH ST
SPRINGDALE AR
72762-6683
US

V. Phone/Fax

Practice location:
  • Phone: 479-738-2878
  • Fax: 479-750-4843
Mailing address:
  • Phone: 479-750-2020
  • Fax: 479-750-4843

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number8075-C
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: