Provider Demographics
NPI:1649779422
Name:NWA THERAPY
Entity Type:Organization
Organization Name:NWA THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:CHANTAL
Authorized Official - Middle Name:AIMEE
Authorized Official - Last Name:CARTER
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW, LADAC, CEDS
Authorized Official - Phone:479-790-2324
Mailing Address - Street 1:2592 N GREGG AVE, SUITE 10
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72703-5520
Mailing Address - Country:US
Mailing Address - Phone:479-790-2324
Mailing Address - Fax:888-965-6911
Practice Address - Street 1:2592 N GREGG AVE, SUITE 10
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:AR
Practice Address - Zip Code:72703-5520
Practice Address - Country:US
Practice Address - Phone:479-790-2324
Practice Address - Fax:888-965-6911
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-07
Last Update Date:2020-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR2292-C1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty