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General NPI Number Information
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NPI Number | 1194076737
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Entity Type | Organization
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Legal Business Name | REHABILITATION & COUNSELING CONSULTANTS
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Dates
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Enumeration Date | 09/23/2012
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Last Update Date | 11/09/2012
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Provider Practice Location Address
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Address Line | 930 WINGATE ST STE D2
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City | CONWAY
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State | AR
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Zip | 72034-4837
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Country | US
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Telephone | 501-499-8699
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Fax | 501-205-4588
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Provider Business Mailing Address
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Address Line | PO BOX 11770
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City | CONWAY
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State | AR
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Zip | 72034-0031
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Country | US
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Telephone | 501-499-8699
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Fax | 501-205-4588
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Authorized Official
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Title or Position | PRESIDENT/CEO
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Name | DR. TRESVIL GERARD PACK
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Credential | PH.D., CRC, LPC
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Telephone | 501-499-8699
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | P1101006
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License Number State | AR
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