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General NPI Number Information
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NPI Number | 1881559029
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Entity Type | Organization
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Legal Business Name | 1501 MICHAEL DRIVE, LLC
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Dates
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Enumeration Date | 12/19/2025
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Last Update Date | 12/19/2025
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Provider Practice Location Address
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Address Line | 1501 MICHAEL DR
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City | LITTLE ROCK
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State | AR
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Zip | 72204-2336
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Country | US
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Telephone | 501-840-5520
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Fax | 501-350-1403
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Provider Business Mailing Address
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Address Line | 10 SHACKLEFORD PLZ STE 102
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City | LITTLE ROCK
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State | AR
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Zip | 72211-1886
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Country | US
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Telephone | 501-224-0846
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Fax | 501-224-0834
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Authorized Official
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Title or Position | PRESIDENT
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Name | GEORGIA JOHNSTON
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Credential |
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Telephone | 501-224-0846
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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