Healthcare Provider Details

I. General information

NPI: 1497585129
Provider Name (Legal Business Name): CREATE SPACE COUNSELING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/06/2024
Last Update Date: 08/06/2024
Certification Date: 08/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

610 N BUCHANAN ST
LITTLE ROCK AR
72205-3208
US

IV. Provider business mailing address

610 N BUCHANAN ST
LITTLE ROCK AR
72205-3208
US

V. Phone/Fax

Practice location:
  • Phone: 501-590-6072
  • Fax:
Mailing address:
  • Phone: 501-590-6072
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number
License Number State

VIII. Authorized Official

Name: ERIN LEA LORENZEN
Title or Position: DIRECTOR
Credential: LPC, LMHC
Phone: 501-590-6072