Healthcare Provider Details

I. General information

NPI: 1366955346
Provider Name (Legal Business Name): PINE BLUFF COUNSELING GROUP, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/13/2017
Last Update Date: 01/07/2025
Certification Date: 01/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3104 S CATALPA ST STE 5
PINE BLUFF AR
71603-4869
US

IV. Provider business mailing address

2106 E 6TH AVE
PINE BLUFF AR
71601-5402
US

V. Phone/Fax

Practice location:
  • Phone: 501-733-5413
  • Fax:
Mailing address:
  • Phone: 501-733-5413
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number7090-C
License Number StateAR

VIII. Authorized Official

Name: CAREY JAMES DOBBINS
Title or Position: OWNER
Credential: LCSW
Phone: 501-733-5413