Healthcare Provider Details

I. General information

NPI: 1457609869
Provider Name (Legal Business Name): ARKANSAS BEHAVIORAL CENTER (ABC), LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/16/2012
Last Update Date: 08/16/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9101 KANIS RD #201
LITTLE ROCK AR
72205-6456
US

IV. Provider business mailing address

9101 KANIS RD #201
LITTLE ROCK AR
72205-6456
US

V. Phone/Fax

Practice location:
  • Phone: 501-960-5779
  • Fax: 501-537-0176
Mailing address:
  • Phone: 501-960-5779
  • Fax: 501-537-0176

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number05-13P
License Number StateAR

VIII. Authorized Official

Name: DR. KRAMEELAH MARSHAE BANKS
Title or Position: PSYCHOLOGIST
Credential: PHD
Phone: 501-960-5779