Healthcare Provider Details

I. General information

NPI: 1043988710
Provider Name (Legal Business Name): SONYA LONG LAC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/30/2021
Last Update Date: 05/27/2026
Certification Date: 05/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10201 W MARKHAM ST STE 350
LITTLE ROCK AR
72205-2195
US

IV. Provider business mailing address

2809 FOREST HOME RD
JONESBORO AR
72401-5320
US

V. Phone/Fax

Practice location:
  • Phone: 501-444-2446
  • Fax:
Mailing address:
  • Phone: 866-972-1268
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberA2209004
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: