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General NPI Number Information
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NPI Number | 1801597026
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Entity Type | Individual
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Provider Name | LINDELLE DIANE FRASER
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Gender | Female
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Dates
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Enumeration Date | 03/14/2023
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Last Update Date | 08/07/2025
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Provider Practice Location Address
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Address Line | 2850 PRINCE ST STE 53
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City | CONWAY
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State | AR
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Zip | 72034-3600
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Country | US
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Telephone | 501-764-3002
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Fax | 866-514-7628
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Provider Business Mailing Address
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Address Line | 2850 PRINCE ST STE 53
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City | CONWAY
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State | AR
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Zip | 72034-3600
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Country | US
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Telephone | 501-764-3002
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Fax | 866-514-7628
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | P2507016
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License Number State | AR
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