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General NPI Number Information
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NPI Number | 1518444843
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Entity Type | Organization
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Legal Business Name | FACE2FACE THERAPY LLC
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Dates
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Enumeration Date | 07/19/2018
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Last Update Date | 03/05/2019
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Provider Practice Location Address
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Address Line | 603 HARKRIDER ST
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City | CONWAY
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State | AR
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Zip | 72032-5633
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Country | US
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Telephone | 501-514-0417
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Fax |
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Provider Business Mailing Address
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Address Line | 603 HARKRIDER ST
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City | CONWAY
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State | AR
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Zip | 72032-5633
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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 | OWNER/MANAGER
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Name | ANGELA CAMPAGNA
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Credential | LCSW
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Telephone | 501-514-0417
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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 | 8136-C
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License Number State | AR
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