Healthcare Provider Details

I. General information

NPI: 1104692193
Provider Name (Legal Business Name): CARE COUNSELING SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/30/2023
Last Update Date: 01/05/2024
Certification Date: 01/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

217 W 2ND ST STE 306
LITTLE ROCK AR
72201-2522
US

IV. Provider business mailing address

9214 TALL TIMBER BLVD
LITTLE ROCK AR
72204-8523
US

V. Phone/Fax

Practice location:
  • Phone: 501-412-0049
  • Fax:
Mailing address:
  • Phone: 501-247-0252
  • Fax: 501-712-4534

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: CRYSTAL STIDUM
Title or Position: OWNER/LICENSED THERAPIST
Credential: LPC
Phone: 501-412-0069