Provider Demographics
NPI:1427204643
Name:WEATHARLY, NATASSIA NICHOLE (LPC)
Entity Type:Individual
Prefix:MS
First Name:NATASSIA
Middle Name:NICHOLE
Last Name:WEATHARLY
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:NATASSIA
Other - Middle Name:NICHOLE
Other - Last Name:BERNARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5905 FOREST PLACE
Mailing Address - Street 2:SUITE 230
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72207
Mailing Address - Country:US
Mailing Address - Phone:501-777-3200
Mailing Address - Fax:
Practice Address - Street 1:5905 FOREST PLACE
Practice Address - Street 2:SUITE 230
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72207
Practice Address - Country:US
Practice Address - Phone:501-777-3200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-08
Last Update Date:2021-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171M00000X
ARP1202024101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No171M00000XOther Service ProvidersCase Manager/Care Coordinator