MEDICARE: DEBORA RIBAS RODRIGUES LAC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	A2510024	AR

General Provider Information

NPI Number	:	1891641940
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DEBORA RIBAS RODRIGUES LAC

Provider Business Mailing Address
First Line	:	1572 N DAWN DR
Second Line	:
City	:	FAYETTEVILLE
State	:	AR
Zip	:	72703-6093
Country	:	US
Telephone Number	:	479-422-3295
Fax Number	:

Provider Business Practice Location Address
First Line	:	112 W CENTER ST STE 420
Second Line	:
City	:	FAYETTEVILLE
State	:	AR
Zip	:	72701-6073
Country	:	US
Telephone Number	:	479-301-5290
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/09/2026
Last Update Date	:	03/09/2026

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