Provider Demographics
NPI:1740836030
Name:ARNOLD, SHONNA MARIE (LAC)
Entity type:Individual
Prefix:
First Name:SHONNA
Middle Name:MARIE
Last Name:ARNOLD
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:SHONNA
Other - Middle Name:MARIE
Other - Last Name:ARNOLD
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:QBHP
Mailing Address - Street 1:1815 PLEASANT GROVE ROAD
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:AR
Mailing Address - Zip Code:72405-7870
Mailing Address - Country:US
Mailing Address - Phone:870-933-6886
Mailing Address - Fax:870-933-9395
Practice Address - Street 1:1815 PLEASANT GROVE ROAD
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:AR
Practice Address - Zip Code:72405-7870
Practice Address - Country:US
Practice Address - Phone:870-933-6886
Practice Address - Fax:870-933-9395
Is Sole Proprietor?:No
Enumeration Date:2019-08-13
Last Update Date:2020-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR171M00000XMedicaid