Provider Demographics
NPI:1679241939
Name:NWA SECOND STAGE TRANSITION
Entity Type:Organization
Organization Name:NWA SECOND STAGE TRANSITION
Other - Org Name:NWA SECOND STAGE TRANSITION
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:CECELIA
Authorized Official - Middle Name:
Authorized Official - Last Name:DORKO
Authorized Official - Suffix:
Authorized Official - Credentials:MASTER DEGREE
Authorized Official - Phone:479-547-3737
Mailing Address - Street 1:608 S HICO ST
Mailing Address - Street 2:
Mailing Address - City:SILOAM SPRINGS
Mailing Address - State:AR
Mailing Address - Zip Code:72761-3740
Mailing Address - Country:US
Mailing Address - Phone:479-549-3737
Mailing Address - Fax:
Practice Address - Street 1:608 S HICO ST
Practice Address - Street 2:
Practice Address - City:SILOAM SPRINGS
Practice Address - State:AR
Practice Address - Zip Code:72761-3740
Practice Address - Country:US
Practice Address - Phone:479-549-3737
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-01
Last Update Date:2022-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR1679241939OtherBEHAVIORAL HEALTH & SOCIAL SERVICE PROVIDERS