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General NPI Number Information
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NPI Number | 1437801164
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Entity Type | Organization
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Legal Business Name | AGAPE CENTER, LLC
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Dates
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Enumeration Date | 01/24/2022
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Last Update Date | 02/28/2022
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Provider Practice Location Address
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Address Line | 3400 SE MACY RD STE 28
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City | BENTONVILLE
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State | AR
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Zip | 72712-7841
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Country | US
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Telephone | 479-321-2818
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Fax | 479-358-1448
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Provider Business Mailing Address
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Address Line | PO BOX 1023
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City | BENTONVILLE
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State | AR
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Zip | 72712-1023
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Country | US
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Telephone | 479-321-2818
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Fax |
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Authorized Official
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Title or Position | OWNER/CLINICIAN
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Name | CORRETTA C WOODARD
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Credential | LPC
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Telephone | 479-321-2818
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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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