Healthcare Provider Details

I. General information

NPI: 1427708643
Provider Name (Legal Business Name): ANDREIA GLIDEWELL LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/29/2022
Last Update Date: 10/23/2024
Certification Date: 10/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4354 STOCKTON DR
NORTH LITTLE ROCK AR
72117-2917
US

IV. Provider business mailing address

4354 STOCKTON DR
NORTH LITTLE ROCK AR
72117-2917
US

V. Phone/Fax

Practice location:
  • Phone: 501-955-7600
  • Fax:
Mailing address:
  • Phone: 501-955-7600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: