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General NPI Number Information
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NPI Number | 1194016519
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Entity Type | Organization
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Legal Business Name | BALANCE ROAD PLLC
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Dates
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Enumeration Date | 04/20/2011
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Last Update Date | 04/20/2011
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Provider Practice Location Address
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Address Line | 1130 E MILLSAP RD
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City | FAYETTEVILLE
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State | AR
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Zip | 72703-5150
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Country | US
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Telephone | 479-422-2280
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Fax | 479-616-1618
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Provider Business Mailing Address
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Address Line | PO BOX 10348
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City | FAYETTEVILLE
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State | AR
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Zip | 72703-0041
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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 | OWNER MANAGER
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Name | DAWNA BISHOP STEVENS
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Credential | LCSW, LADAC, SAP
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Telephone | 479-422-2280
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 2535-C
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License Number State | AR
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