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General NPI Number Information
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NPI Number | 1417609744
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Entity Type | Organization
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Legal Business Name | RESILIENT WAVES COUNSELING LLC
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Dates
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Enumeration Date | 01/18/2022
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Last Update Date | 11/04/2022
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Provider Practice Location Address
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Address Line | 3811 ROGERS AVE STE C7
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City | FORT SMITH
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State | AR
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Zip | 72903-3045
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Country | US
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Telephone | 479-430-2300
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Fax | 844-430-0199
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Provider Business Mailing Address
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Address Line | 3811 ROGERS AVE STE C7
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City | FORT SMITH
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State | AR
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Zip | 72903-3045
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Country | US
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Telephone | 479-430-2300
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Fax | 844-430-0199
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Authorized Official
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Title or Position | PRESIDENT
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Name | REIANNA GARNER
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Credential | LPC
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Telephone | 479-430-2300
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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