Healthcare Provider Details

I. General information

NPI: 1922694116
Provider Name (Legal Business Name): KOLA LANETTE BROWN LAC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/12/2020
Last Update Date: 05/27/2025
Certification Date: 05/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

205 W BOND AVE
WEST MEMPHIS AR
72301-3907
US

IV. Provider business mailing address

PO BOX 1523
NORTH LITTLE ROCK AR
72115-1523
US

V. Phone/Fax

Practice location:
  • Phone: 870-400-8079
  • Fax:
Mailing address:
  • Phone: 501-303-6278
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225C00000X
TaxonomyRehabilitation Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberA1803023
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: