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General NPI Number Information
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NPI Number | 1194188912
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Entity Type | Organization
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Legal Business Name | CHRISTIAN COUNSELING OF ARKANSAS-JONESBORO
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Dates
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Enumeration Date | 03/30/2016
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Last Update Date | 03/30/2016
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Provider Practice Location Address
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Address Line | 1717 EXECUTIVE SQ
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City | JONESBORO
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State | AR
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Zip | 72401-6091
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Country | US
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Telephone | 870-935-4102
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Fax |
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Provider Business Mailing Address
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Address Line | 2703 NIX LN
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City | JONESBORO
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State | AR
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Zip | 72404-6988
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Country | US
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Telephone | 870-935-4102
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MRS. LAURA R HODGES
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Credential | LPC
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Telephone | 870-935-4102
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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 | P1508087
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License Number State | AR
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