Provider Demographics
NPI:1689779886
Name:BROCK, DAVA LORENE (LPC)
Entity Type:Individual
Prefix:MRS
First Name:DAVA
Middle Name:LORENE
Last Name:BROCK
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2796 S 2ND ST STE E
Mailing Address - Street 2:
Mailing Address - City:CABOT
Mailing Address - State:AR
Mailing Address - Zip Code:72023-7043
Mailing Address - Country:US
Mailing Address - Phone:844-514-5183
Mailing Address - Fax:501-286-6046
Practice Address - Street 1:2796 S 2ND ST STE E
Practice Address - Street 2:
Practice Address - City:CABOT
Practice Address - State:AR
Practice Address - Zip Code:72023-7043
Practice Address - Country:US
Practice Address - Phone:844-514-5183
Practice Address - Fax:501-286-6046
Is Sole Proprietor?:No
Enumeration Date:2006-09-13
Last Update Date:2023-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARP0711062101YP2500X
ARA0403016101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional