Healthcare Provider Details

I. General information

NPI: 1861831349
Provider Name (Legal Business Name): FAIZA SHEIKH SAMAD M.ED
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/18/2013
Last Update Date: 01/10/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

102 COUNTRY CLUB PKWY
MAUMELLE AR
72113-6705
US

IV. Provider business mailing address

575 CLUB LN SUITE 103
CONWAY AR
72034-3681
US

V. Phone/Fax

Practice location:
  • Phone: 832-276-4663
  • Fax:
Mailing address:
  • Phone: 832-276-4663
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberP1509106
License Number StateAR
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number70735
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: