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General NPI Number Information
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NPI Number | 1649779422
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Entity Type | Organization
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Legal Business Name | NWA THERAPY
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Dates
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Enumeration Date | 02/07/2018
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Last Update Date | 01/28/2020
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Provider Practice Location Address
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Address Line | 2592 N GREGG AVE, SUITE 10
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City | FAYETTEVILLE
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State | AR
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Zip | 72703-5520
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Country | US
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Telephone | 479-790-2324
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Fax | 888-965-6911
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Provider Business Mailing Address
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Address Line | 2592 N GREGG AVE, SUITE 10
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City | FAYETTEVILLE
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State | AR
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Zip | 72703-5520
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Country | US
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Telephone | 479-790-2324
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Fax | 888-965-6911
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Authorized Official
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Title or Position | OWNER/THERAPIST
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Name | CHANTAL AIMEE CARTER
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Credential | LCSW, LADAC, CEDS
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Telephone | 479-790-2324
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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 | 2292-C
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License Number State | AR
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