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General NPI Number Information
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NPI Number | 1023756574
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Entity Type | Organization
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Legal Business Name | KINGDOM CONNECT CONSULTING SERVICES, LLC
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Dates
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Enumeration Date | 05/24/2022
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Last Update Date | 08/03/2022
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Provider Practice Location Address
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Address Line | 162 MOUND CITY RD
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City | MARION
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State | AR
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Zip | 72364-1830
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Country | US
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Telephone | 870-945-5292
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1354
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City | FORREST CITY
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State | AR
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Zip | 72336-1354
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Country | US
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Telephone | 870-945-5292
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | REDA V KIRKWOOD
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Credential | LCSW
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Telephone | 870-945-5292
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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