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107 N Boston Pl Russellville AR 72801-3940 | |
| (479) 219-4100 | |
| (479) 222-0049 |
| Full Name | |
|---|---|
| Speciality | Counselor - Addiction (substance Use Disorder) |
| Location | 107 N Boston Pl, Russellville, Arkansas |
| Authorized Official Name and Position | Mary Caitlin Conner (CLINICAL DIRECTOR) |
| Authorized Official Contact | 4792194100 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
Po Box 9178 Russellville AR 72811-9178 Ph: (008) 244-0948 | 107 N Boston Pl Russellville AR 72801-3940 Ph: (479) 219-4100 |
| NPI Number | 1558727024 |
|---|---|
| Provider Enumeration Date | 01/13/2016 |
| Last Update Date | 12/17/2024 |
| Certification Date | 12/17/2024 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1558727024 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YA0400X | Counselor - Addiction (substance Use Disorder) | (* (Not Available)) | Primary |
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