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General NPI Number Information
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NPI Number | 1184390981
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Entity Type | Individual
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Provider Name | NATHAN WINIECKI LAC
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Gender | Male
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Dates
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Enumeration Date | 08/20/2021
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Last Update Date | 03/01/2024
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Provider Practice Location Address
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Address Line | 500 HILL FARM RD
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City | BRYANT
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State | AR
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Zip | 72022-3804
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Country | US
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Telephone | 501-653-5015
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Fax |
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Provider Business Mailing Address
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Address Line | 106 SIXTH ST
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City | CHARLESTON
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State | AR
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Zip | 72933-7027
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Country | US
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Telephone | 15-765-0881
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | P2402003
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License Number State | AR
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