Healthcare Provider Details

I. General information

NPI: 1194587204
Provider Name (Legal Business Name): CARTER SHIELDS LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/24/2024
Last Update Date: 07/20/2026
Certification Date: 07/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

513 MAIN ST
NORTH LITTLE ROCK AR
72114-5329
US

IV. Provider business mailing address

513 MAIN ST
NORTH LITTLE ROCK AR
72114-5329
US

V. Phone/Fax

Practice location:
  • Phone: 501-777-5969
  • Fax: 501-379-9791
Mailing address:
  • Phone: 501-777-5969
  • Fax: 501-379-9791

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberP2607001
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: