Healthcare Provider Details

I. General information

NPI: 1801330584
Provider Name (Legal Business Name): AUNGELIQUE SLEDGE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/14/2016
Last Update Date: 02/08/2021
Certification Date: 02/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6210 BASELINE RD
LITTLE ROCK AR
72209-4728
US

IV. Provider business mailing address

6210 BASELINE RD
LITTLE ROCK AR
72209-4728
US

V. Phone/Fax

Practice location:
  • Phone: 501-265-0302
  • Fax: 501-265-0300
Mailing address:
  • Phone: 501-265-0302
  • Fax: 501-265-0300

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberP1912141
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: