Provider Demographics
NPI:1326530585
Name:SACRED TRUST CHRISTIAN COUNSELING
Entity Type:Organization
Organization Name:SACRED TRUST CHRISTIAN COUNSELING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:CASONDRA
Authorized Official - Middle Name:RENEE
Authorized Official - Last Name:ROBINSON
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, THD
Authorized Official - Phone:800-395-4564
Mailing Address - Street 1:PO BOX 2431
Mailing Address - Street 2:
Mailing Address - City:CONWAY
Mailing Address - State:AR
Mailing Address - Zip Code:72033-2431
Mailing Address - Country:US
Mailing Address - Phone:800-395-4564
Mailing Address - Fax:410-449-6336
Practice Address - Street 1:1720 SIMMS ST
Practice Address - Street 2:
Practice Address - City:CONWAY
Practice Address - State:AR
Practice Address - Zip Code:72034-6416
Practice Address - Country:US
Practice Address - Phone:800-395-4564
Practice Address - Fax:410-449-6336
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-04
Last Update Date:2018-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH121001251S00000X, 261QM0855X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health