Healthcare Provider Details

I. General information

NPI: 1669853081
Provider Name (Legal Business Name): ARKANSAS ADULT PSYCHOTHERAPY CENTER, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/11/2015
Last Update Date: 09/30/2025
Certification Date: 09/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5401 JFK STE I
NORTH LITTLE ROCK AR
72116-6740
US

IV. Provider business mailing address

5401 JFK BLVD STE I
NORTH LITTLE ROCK AR
72116-6740
US

V. Phone/Fax

Practice location:
  • Phone: 501-771-4693
  • Fax: 501-771-4885
Mailing address:
  • Phone: 501-758-9993
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: DAHLIA DANNETTA DISTIN
Title or Position: OWNER
Credential:
Phone: 501-758-9993