Healthcare Provider Details

I. General information

NPI: 1326969213
Provider Name (Legal Business Name): THE SOVEREIGN COLLECTIVE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/24/2026
Last Update Date: 07/24/2026
Certification Date: 07/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

415 N MCKINLEY ST STE 465B
LITTLE ROCK AR
72205-3017
US

IV. Provider business mailing address

415 N MCKINLEY ST STE 465B
LITTLE ROCK AR
72205-3017
US

V. Phone/Fax

Practice location:
  • Phone: 501-216-1212
  • Fax: 501-216-1212
Mailing address:
  • Phone: 501-216-1212
  • Fax: 501-216-1212

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: THOMASENA LAMENA MCNUTT
Title or Position: CHIEF EXECUTIVE OFFICER/OWNER
Credential: DR.
Phone: 501-830-9800