Healthcare Provider Details

I. General information

NPI: 1669187514
Provider Name (Legal Business Name): CARLEY A QUINN MS, LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/16/2023
Last Update Date: 01/02/2025
Certification Date: 01/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 S PROMENADE BLVD
ROGERS AR
72758-9073
US

IV. Provider business mailing address

2000 S PROMENADE BLVD
ROGERS AR
72758-9073
US

V. Phone/Fax

Practice location:
  • Phone: 479-408-4197
  • Fax:
Mailing address:
  • Phone: 479-408-4197
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number2301006
License Number StateAR
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberP2412021
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: