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1100 N College Ave Fayetteville AR 72703-1944 | |
| (479) 444-5048 | |
| (479) 444-5039 |
| Full Name | |
|---|---|
| Speciality | Counselor - Addiction (substance Use Disorder) |
| Location | 1100 N College Ave, Fayetteville, Arkansas |
| Authorized Official Name and Position | Cindy Farmer (COMPLIANCE OFFICER) |
| Authorized Official Contact | 4794444301 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
2932 N Bluegrass Pl Fayetteville AR 72704-6032 Ph: (479) 841-7562 | 1100 N College Ave Fayetteville AR 72703-1944 Ph: (479) 444-5048 |
| NPI Number | 1043393242 |
|---|---|
| Provider Enumeration Date | 10/23/2006 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1043393242 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YA0400X | Counselor - Addiction (substance Use Disorder) | P8812027 (Arkansas) | Primary |
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