Provider Demographics
NPI:1629602008
Name:ROSE COUNSELING AND CONSULTING PLLC
Entity Type:Organization
Organization Name:ROSE COUNSELING AND CONSULTING PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MIA
Authorized Official - Middle Name:
Authorized Official - Last Name:GORDON
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:501-679-1469
Mailing Address - Street 1:425 W CAPITOL AVE STE 1213
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72201-3405
Mailing Address - Country:US
Mailing Address - Phone:501-679-1469
Mailing Address - Fax:
Practice Address - Street 1:425 W CAPITOL AVE STE 1213
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72201-3405
Practice Address - Country:US
Practice Address - Phone:501-679-1469
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-25
Last Update Date:2023-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center