Provider Demographics
NPI:1194188912
Name:CHRISTIAN COUNSELING OF ARKANSAS-JONESBORO
Entity Type:Organization
Organization Name:CHRISTIAN COUNSELING OF ARKANSAS-JONESBORO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:R
Authorized Official - Last Name:HODGES
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:870-935-4102
Mailing Address - Street 1:2703 NIX LN
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:AR
Mailing Address - Zip Code:72404-6988
Mailing Address - Country:US
Mailing Address - Phone:870-935-4102
Mailing Address - Fax:
Practice Address - Street 1:1717 EXECUTIVE SQ
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:AR
Practice Address - Zip Code:72401-6091
Practice Address - Country:US
Practice Address - Phone:870-935-4102
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-30
Last Update Date:2016-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARP1508087251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health