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General NPI Number Information
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NPI Number | 1003682196
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Entity Type | Individual
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Provider Name | ABIGAIL CAMPBELL LAC
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Gender | Female
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Dates
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Enumeration Date | 11/29/2023
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Last Update Date | 10/11/2024
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Provider Practice Location Address
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Address Line | 1 LILE CT STE 200
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City | LITTLE ROCK
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State | AR
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Zip | 72205-6240
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Country | US
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Telephone | 479-964-2011
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Fax |
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Provider Business Mailing Address
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Address Line | 324 FLETCHER LOOP
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City | LITTLE ROCK
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State | AR
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Zip | 72223-9076
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Country | US
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Telephone | 601-454-1169
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number | A2409009
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License Number State | AR
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