=====================================================
General NPI Number Information
=====================================================
NPI Number | 1629583182
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ATTACHMENT SERVICES OF ARKANSAS
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/06/2017
-----------------------------------------------------
Last Update Date | 01/04/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5800 EVERGREEN DR STE G
-----------------------------------------------------
City | LITTLE ROCK
-----------------------------------------------------
State | AR
-----------------------------------------------------
Zip | 72205-1757
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 501-414-9141
-----------------------------------------------------
Fax | 501-904-4409
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 217 JOHNSON ST
-----------------------------------------------------
City | LITTLE ROCK
-----------------------------------------------------
State | AR
-----------------------------------------------------
Zip | 72205-5823
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 501-414-9141
-----------------------------------------------------
Fax | 501-904-4409
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ORGANIZER
-----------------------------------------------------
Name | CINDY A BROWN
-----------------------------------------------------
Credential | LCSW
-----------------------------------------------------
Telephone | 501-414-9141
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | 3376-C
-----------------------------------------------------
License Number State | AR
-----------------------------------------------------