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General NPI Number Information
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NPI Number | 1326530585
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Entity Type | Organization
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Legal Business Name | SACRED TRUST CHRISTIAN COUNSELING
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Dates
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Enumeration Date | 06/04/2018
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Last Update Date | 06/04/2018
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Provider Practice Location Address
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Address Line | 1720 SIMMS ST
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City | CONWAY
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State | AR
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Zip | 72034-6416
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Country | US
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Telephone | 800-395-4564
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Fax | 410-449-6336
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Provider Business Mailing Address
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Address Line | PO BOX 2431
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City | CONWAY
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State | AR
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Zip | 72033-2431
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Country | US
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Telephone | 800-395-4564
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Fax | 410-449-6336
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Authorized Official
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Title or Position | CEO
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Name | DR. CASONDRA RENEE ROBINSON
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Credential | PHD, THD
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Telephone | 800-395-4564
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0855X
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Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
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License Number | 121001
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 121001
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License Number State | OH
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