Provider Demographics
NPI:1568131076
Name:CONNER, GARRICK DEWAYNE (MA, LPC, LMFT)
Entity Type:Individual
Prefix:MR
First Name:GARRICK
Middle Name:DEWAYNE
Last Name:CONNER
Suffix:
Gender:M
Credentials:MA, LPC, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8001 N HILLS BLVD
Mailing Address - Street 2:
Mailing Address - City:NORTH LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72116-4904
Mailing Address - Country:US
Mailing Address - Phone:501-551-4144
Mailing Address - Fax:
Practice Address - Street 1:209 ROYA LANE, STE. 4
Practice Address - Street 2:
Practice Address - City:BRYANT
Practice Address - State:AR
Practice Address - Zip Code:72022-7211
Practice Address - Country:US
Practice Address - Phone:501-551-4144
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-08
Last Update Date:2021-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARP1308092101YP2500X
ARM1308044106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist