Provider Demographics
NPI:1275410706
Name:INTENTIONAL CONNECTIONS COUNSELING & CONSULTING LLC
Entity type:Organization
Organization Name:INTENTIONAL CONNECTIONS COUNSELING & CONSULTING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CANDICE
Authorized Official - Middle Name:
Authorized Official - Last Name:HENDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:LADAC
Authorized Official - Phone:501-764-8809
Mailing Address - Street 1:500 AMITY RD STE B
Mailing Address - Street 2:
Mailing Address - City:CONWAY
Mailing Address - State:AR
Mailing Address - Zip Code:72032-5948
Mailing Address - Country:US
Mailing Address - Phone:501-764-8809
Mailing Address - Fax:
Practice Address - Street 1:500 AMITY RD STE B
Practice Address - Street 2:
Practice Address - City:CONWAY
Practice Address - State:AR
Practice Address - Zip Code:72032-5948
Practice Address - Country:US
Practice Address - Phone:501-764-8809
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-08-18
Last Update Date:2025-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty