| Healing Identities Counseling Services Llc | |
|
900 Dorman St Ste A Springdale AR 72762-5101 | |
| (479) 755-3501 | |
| Not Available |
| Full Name | Healing Identities Counseling Services Llc |
|---|---|
| Speciality | Social Worker |
| Location | 900 Dorman St Ste A, Springdale, Arkansas |
| Authorized Official Name and Position | Kanaka Keonne Henry (OWNER) |
| Authorized Official Contact | 8702538082 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Healing Identities Counseling Services Llc 900 Dorman St Ste A Springdale AR 72762-5101 Ph: (479) 755-3501 | Healing Identities Counseling Services Llc 900 Dorman St Ste A Springdale AR 72762-5101 Ph: (479) 755-3501 |
| NPI Number | 1548017312 |
|---|---|
| Provider Enumeration Date | 05/01/2024 |
| Last Update Date | 05/28/2024 |
| Certification Date | 05/28/2024 |
| Medicare PECOS PAC ID | 5597201434 |
|---|---|
| Medicare Enrollment ID | O20240726002599 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1548017312 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
| Provider Name | Kanaka Henry |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1831343243 PECOS PAC ID: 7315223492 Enrollment ID: I20170405000372 |
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