Provider Demographics
NPI:1003684929
Name:KIVI, ALMA (MS LAC)
Entity Type:Individual
Prefix:
First Name:ALMA
Middle Name:
Last Name:KIVI
Suffix:
Gender:F
Credentials:MS LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:303 SE HENDRIX ST
Mailing Address - Street 2:
Mailing Address - City:BENTONVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72712-3931
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2105 S 54TH ST 2
Practice Address - Street 2:#2
Practice Address - City:ROGERS
Practice Address - State:AR
Practice Address - Zip Code:72758-8191
Practice Address - Country:US
Practice Address - Phone:479-373-2377
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-20
Last Update Date:2023-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA1912190101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health