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General NPI Number Information
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NPI Number | 1801048939
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Entity Type | Individual
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Provider Name | ANGELA ETCHISON M.S.
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Gender | Female
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Dates
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Enumeration Date | 10/21/2008
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Last Update Date | 08/26/2020
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Provider Practice Location Address
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Address Line | 13024 STACY LN
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City | LITTLE ROCK
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State | AR
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Zip | 72211-3239
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Country | US
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Telephone | 501-868-4900
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Fax | 501-868-4901
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Provider Business Mailing Address
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Address Line | 13024 STACY LN
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City | LITTLE ROCK
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State | AR
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Zip | 72211-3239
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Country | US
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Telephone | 501-868-4900
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Fax | 501-868-4901
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 05-06EI
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License Number State | AR
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