Healthcare Provider Details

I. General information

NPI: 1629811310
Provider Name (Legal Business Name): VIDA COLLECTIVE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/18/2024
Last Update Date: 03/13/2026
Certification Date: 03/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

420 E 21ST ST STE G
LITTLE ROCK AR
72206-2350
US

IV. Provider business mailing address

420 E 21ST ST STE G
LITTLE ROCK AR
72206-2350
US

V. Phone/Fax

Practice location:
  • Phone: 501-300-7456
  • Fax: 501-600-4811
Mailing address:
  • Phone: 501-300-7456
  • Fax: 501-600-4811

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: ANA R ELDRIDGE
Title or Position: OWNER
Credential: LPC
Phone: 501-300-7456