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General NPI Number Information
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NPI Number | 1043630734
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Entity Type | Organization
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Legal Business Name | THE SAGE CENTER FOR TRAUMA AND WELLNESS, PLLC
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Dates
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Enumeration Date | 04/21/2014
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Last Update Date | 04/21/2014
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Provider Practice Location Address
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Address Line | 2725 CANTRELL RD STE 105
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City | LITTLE ROCK
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State | AR
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Zip | 72202-2044
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Country | US
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Telephone | 501-400-8850
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Fax | 501-400-8839
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Provider Business Mailing Address
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Address Line | 2725 CANTRELL RD STE 105
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City | LITTLE ROCK
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State | AR
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Zip | 72202-2044
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Country | US
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Telephone | 501-400-8850
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Fax | 501-400-8839
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Authorized Official
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Title or Position | CO-OWNER
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Name | MS. ELIZABETH GRACE WHITE
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Credential | LCSW
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Telephone | 501-681-3001
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 11-25P
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License Number State | AR
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 6256-C
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License Number State | AR
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