Provider Demographics
NPI:1477195576
Name:DEL BUSTO, STEVIE (LAC)
Entity Type:Individual
Prefix:
First Name:STEVIE
Middle Name:
Last Name:DEL BUSTO
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:204 N FRONT ST STE A
Mailing Address - Street 2:
Mailing Address - City:DARDANELLE
Mailing Address - State:AR
Mailing Address - Zip Code:72834-3843
Mailing Address - Country:US
Mailing Address - Phone:479-355-1606
Mailing Address - Fax:479-782-5502
Practice Address - Street 1:204 N FRONT ST STE A
Practice Address - Street 2:
Practice Address - City:DARDANELLE
Practice Address - State:AR
Practice Address - Zip Code:72834-3843
Practice Address - Country:US
Practice Address - Phone:479-355-1606
Practice Address - Fax:479-782-5502
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-10
Last Update Date:2019-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA190445101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty