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General NPI Number Information
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NPI Number | 1902630023
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Entity Type | Organization
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Legal Business Name | LIFE ANEW THERAPY AND CONSULTING, PLLC
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Dates
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Enumeration Date | 08/30/2024
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Last Update Date | 09/12/2024
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Provider Practice Location Address
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Address Line | 400 W CAPITOL AVE STE 1700
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City | LITTLE ROCK
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State | AR
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Zip | 72201-3438
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Country | US
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Telephone | 501-209-7522
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Fax |
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Provider Business Mailing Address
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Address Line | 400 W CAPITOL AVE STE 1700
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City | LITTLE ROCK
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State | AR
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Zip | 72201-3438
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Country | US
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Telephone | 501-209-7522
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Fax |
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Authorized Official
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Title or Position | OWNER/CLINICAL MANAGER
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Name | SHANTE MORMON
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Credential | LCSW
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Telephone | 501-209-7522
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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 |
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License Number State |
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