Provider Demographics
NPI:1508174707
Name:EARHART, EUGENA NICOLE
Entity Type:Individual
Prefix:
First Name:EUGENA
Middle Name:NICOLE
Last Name:EARHART
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2153 E JOYCE BLVD
Mailing Address - Street 2:STE 201
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72703-4714
Mailing Address - Country:US
Mailing Address - Phone:479-575-9471
Mailing Address - Fax:479-587-9392
Practice Address - Street 1:250 E CENTERTON BLVD
Practice Address - Street 2:
Practice Address - City:CENTERTON
Practice Address - State:AR
Practice Address - Zip Code:72719-9240
Practice Address - Country:US
Practice Address - Phone:479-795-0503
Practice Address - Fax:479-795-8303
Is Sole Proprietor?:No
Enumeration Date:2010-09-22
Last Update Date:2010-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor