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General NPI Number Information
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NPI Number | 1053833939
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Entity Type | Organization
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Legal Business Name | WELLSPRING RENEWAL CENTER
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Dates
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Enumeration Date | 07/12/2017
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Last Update Date | 07/12/2017
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Provider Practice Location Address
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Address Line | 101 N WOODROW ST
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City | LITTLE ROCK
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State | AR
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Zip | 72205-4341
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Country | US
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Telephone | 15012650046
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Fax |
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Provider Business Mailing Address
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Address Line | 101 N WOODROW ST
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City | LITTLE ROCK
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State | AR
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Zip | 72205-4341
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Country | US
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Telephone | 15012650046
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | REBECCA SPOONER
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Credential | LPC
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Telephone | 501-265-0046
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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 | P1101005
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License Number State | AR
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