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General NPI Number Information
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NPI Number | 1932358751
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Entity Type | Individual
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Provider Name | PEGGY SUE RATLIFF LPC
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Gender | Female
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Dates
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Enumeration Date | 09/17/2008
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Last Update Date | 02/15/2024
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Provider Practice Location Address
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Address Line | 1058 FRONT ST STE 104
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City | CONWAY
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State | AR
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Zip | 72032-4337
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Country | US
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Telephone | 501-504-2092
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Fax | 501-504-2093
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Provider Business Mailing Address
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Address Line | 11 OAK CLIFF CV
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City | DAMASCUS
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State | AR
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Zip | 72039-9265
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Country | US
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Telephone | 501-335-9278
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Fax |
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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 | P2308029
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License Number State | AR
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