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General NPI Number Information
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NPI Number | 1336633387
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Entity Type | Organization
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Legal Business Name | CENTER FOR EATING DISORDERS AND BEHAVIORAL WELLNESS PLC
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Dates
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Enumeration Date | 06/21/2018
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Last Update Date | 03/28/2021
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Provider Practice Location Address
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Address Line | 218 UNION ST STE C
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City | JONESBORO
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State | AR
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Zip | 72401-2831
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Country | US
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Telephone | 870-530-6104
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Fax |
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Provider Business Mailing Address
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Address Line | 218 UNION ST STE C
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City | JONESBORO
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State | AR
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Zip | 72401-2831
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Country | US
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Telephone | 870-530-6104
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | KEENA REDDIN
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Credential |
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Telephone | 870-761-4796
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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 | 6572-C
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License Number State | AR
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