Healthcare Provider Details

I. General information

NPI: 1760755888
Provider Name (Legal Business Name): ROSA'S THERAPEUTIC CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/21/2012
Last Update Date: 04/12/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10201 W MARKHAM ST STE 208
LITTLE ROCK AR
72205-2181
US

IV. Provider business mailing address

10201 W MARKHAM ST STE 208
LITTLE ROCK AR
72205-2181
US

V. Phone/Fax

Practice location:
  • Phone: 501-551-5980
  • Fax:
Mailing address:
  • Phone: 501-551-5980
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code302F00000X
TaxonomyExclusive Provider Organization
License Number2577-C
License Number StateAR
# 2
Primary TaxonomyN
Taxonomy Code302R00000X
TaxonomyHealth Maintenance Organization
License Number2577-C
License Number StateAR
# 3
Primary TaxonomyY
Taxonomy Code305R00000X
TaxonomyPreferred Provider Organization
License Number2577-C
License Number StateAR

VIII. Authorized Official

Name: MS. ROSE MARY THOMPSON
Title or Position: THERAPIST
Credential: LCSW
Phone: 501-551-5980