Healthcare Provider Details

I. General information

NPI: 1568048296
Provider Name (Legal Business Name): CHANTERICA LEONETTE WARE LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2021
Last Update Date: 05/06/2026
Certification Date: 05/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 LILE CT STE 200
LITTLE ROCK AR
72205-6240
US

IV. Provider business mailing address

1310 W MAIN ST STE 201
RUSSELLVILLE AR
72801-2803
US

V. Phone/Fax

Practice location:
  • Phone: 501-663-1837
  • Fax: 501-663-1839
Mailing address:
  • Phone: 479-968-2001
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberP2605002
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: