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General NPI Number Information
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NPI Number | 1013461987
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Entity Type | Organization
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Legal Business Name | JEFFERSON COMPREHENSIVE COUNSELING ASSOCIATES
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Dates
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Enumeration Date | 08/09/2016
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Last Update Date | 08/09/2016
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Provider Practice Location Address
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Address Line | 2304 W 29TH AVE
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City | PINE BLUFF
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State | AR
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Zip | 71603-5005
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Country | US
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Telephone | 870-247-5222
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Fax | 870-671-4847
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Provider Business Mailing Address
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Address Line | PO BOX 21203
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City | WHITE HALL
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State | AR
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Zip | 71612-1203
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Country | US
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Telephone | 870-247-5222
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Fax | 870-671-4847
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Authorized Official
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Title or Position | CLINICAL DIRECTOR
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Name | MR. SCOTT AARON MABRY
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Credential | CADC, CCS
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Telephone | 870-247-5222
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0405X
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Taxonomy Name | Substance Use Disorder Rehabilitation Clinic/Center
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License Number |
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License Number State |
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