| Collaborative Counseling Associates, Pllc | |
|
1408 S Schiller St Little Rock AR 72202-5817 | |
| (501) 507-0675 | |
| (501) 421-0107 |
| Full Name | Collaborative Counseling Associates, Pllc |
|---|---|
| Speciality | Clinic/Center |
| Location | 1408 S Schiller St, Little Rock, Arkansas |
| Authorized Official Name and Position | Andrea M Fresh (INCORPORATOR/ MANAGING MEMBER) |
| Authorized Official Contact | 5014422293 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Collaborative Counseling Associates, Pllc 1408 S Schiller St Little Rock AR 72202-5817 Ph: (501) 507-0675 | Collaborative Counseling Associates, Pllc 1408 S Schiller St Little Rock AR 72202-5817 Ph: (501) 507-0675 |
| NPI Number | 1922534882 |
|---|---|
| Provider Enumeration Date | 05/11/2017 |
| Last Update Date | 11/30/2020 |
| Certification Date | 11/30/2020 |
| Medicare PECOS PAC ID | 6507296084 |
|---|---|
| Medicare Enrollment ID | O20200423003607 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1922534882 | NPI | - | NPPES |
| Provider Name | Gertrude T Thompkins |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1619000601 PECOS PAC ID: 6507181922 Enrollment ID: I20150206000226 |
| Provider Name | Candace A Baker |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1972899052 PECOS PAC ID: 3577846187 Enrollment ID: I20170206001140 |
| Provider Name | Andrea M Fresh |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1316190259 PECOS PAC ID: 5395014948 Enrollment ID: I20170713000601 |
| Provider Name | Mia Polk |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1861572380 PECOS PAC ID: 4082974589 Enrollment ID: I20180201000009 |
| Provider Name | Mika T Gill |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1144500570 PECOS PAC ID: 1850715608 Enrollment ID: I20200727001312 |
| Provider Name | Dwight Merritt |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1558431684 PECOS PAC ID: 7214323542 Enrollment ID: I20220413000843 |
| Provider Name | Kimberly Robinson |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1578738761 PECOS PAC ID: 5799172789 Enrollment ID: I20220421000486 |
| Provider Name | Robert Irby |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1508011578 PECOS PAC ID: 6204211402 Enrollment ID: I20220923000087 |
| Provider Name | Shanice Fuller |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1386043537 PECOS PAC ID: 4981072022 Enrollment ID: I20221122001179 |
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