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General NPI Number Information
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NPI Number | 1144041633
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Entity Type | Organization
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Legal Business Name | MARRYLAND THERAPY AND CONSULTATION LLC
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Dates
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Enumeration Date | 10/18/2024
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Last Update Date | 10/21/2024
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Provider Practice Location Address
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Address Line | 3508 JOHN F KENNEDY BLVD STE 2
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City | NORTH LITTLE ROCK
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State | AR
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Zip | 72116-8843
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Country | US
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Telephone | 501-613-7831
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 94554
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City | NORTH LITTLE ROCK
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State | AR
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Zip | 72190-4554
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | MRS. LECOLE BARNES
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Credential | LCSW
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Telephone | 501-827-8126
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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