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General NPI Number Information
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NPI Number | 1346890027
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Entity Type | Organization
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Legal Business Name | CREATIVE COUNSELING CENTER OF NWA, PLLC
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Dates
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Enumeration Date | 09/16/2019
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Last Update Date | 09/16/2019
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Provider Practice Location Address
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Address Line | 902 MCCLAIN RD STE 6003
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City | BENTONVILLE
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State | AR
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Zip | 72712-6379
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Country | US
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Telephone | 479-257-1919
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Fax |
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Provider Business Mailing Address
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Address Line | 902 MCCLAIN RD STE 6003
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City | BENTONVILLE
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State | AR
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Zip | 72712-6379
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CO OWNER
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Name | CHARLOTTE EVANS
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Credential | LPC
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Telephone | 479-257-1919
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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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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State |
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