Healthcare Provider Details

I. General information

NPI: 1881197697
Provider Name (Legal Business Name): NWA CHRISTIAN COUNSELING GROUP, INC. DBA BROOKWAY COUNSELING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/18/2018
Last Update Date: 05/05/2021
Certification Date: 05/05/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 CARLTON ST
SPRINGDALE AR
72762-5105
US

IV. Provider business mailing address

801 CARLTON ST
SPRINGDALE AR
72762-5105
US

V. Phone/Fax

Practice location:
  • Phone: 479-255-5414
  • Fax: 855-277-8988
Mailing address:
  • Phone: 479-466-3783
  • Fax: 855-277-8988

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number1258-C
License Number StateAR
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number1258-C
License Number StateAR

VIII. Authorized Official

Name: ANDREA NEULS
Title or Position: AM
Credential:
Phone: 518-571-0867