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General NPI Number Information
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NPI Number | 1255147708
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Entity Type | Organization
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Legal Business Name | NEW ROOTS COUNSELING SERVICES, LLC
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Dates
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Enumeration Date | 12/09/2024
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Last Update Date | 03/26/2025
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Provider Practice Location Address
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Address Line | 318 W 2ND ST
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City | WARD
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State | AR
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Zip | 72176-7725
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Country | US
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Telephone | 501-239-4010
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Fax | 501-239-4020
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Provider Business Mailing Address
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Address Line | PO BOX 11
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City | WARD
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State | AR
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Zip | 72176-0011
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Country | US
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Telephone | 501-239-4010
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Fax | 501-239-4020
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Authorized Official
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Title or Position | GENERAL PARTNER
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Name | JOCELYN PANNELL
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Credential | LCSW
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Telephone | 501-239-4010
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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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