Healthcare Provider Details

I. General information

NPI: 1770735839
Provider Name (Legal Business Name): TIFFANY CUNNINGHAM SLOAN LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/21/2008
Last Update Date: 11/07/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2239 S CARAWAY RD STE M
JONESBORO AR
72401-6234
US

IV. Provider business mailing address

1600 ALDERSGATE RD STE 200
LITTLE ROCK AR
72205-6676
US

V. Phone/Fax

Practice location:
  • Phone: 870-910-3757
  • Fax:
Mailing address:
  • Phone: 501-661-0720
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberP1205054
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: