Healthcare Provider Details

I. General information

NPI: 1881559029
Provider Name (Legal Business Name): 1501 MICHAEL DRIVE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/19/2025
Last Update Date: 12/19/2025
Certification Date: 12/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1501 MICHAEL DR
LITTLE ROCK AR
72204-2336
US

IV. Provider business mailing address

10 SHACKLEFORD PLZ STE 102
LITTLE ROCK AR
72211-1886
US

V. Phone/Fax

Practice location:
  • Phone: 501-840-5520
  • Fax: 501-350-1403
Mailing address:
  • Phone: 501-224-0846
  • Fax: 501-224-0834

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: GEORGIA JOHNSTON
Title or Position: PRESIDENT
Credential:
Phone: 501-224-0846