Provider Demographics
NPI:1922534882
Name:COLLABORATIVE COUNSELING ASSOCIATES, PLLC
Entity Type:Organization
Organization Name:COLLABORATIVE COUNSELING ASSOCIATES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INCORPORATOR/ MANAGING MEMBER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANDREA
Authorized Official - Middle Name:M
Authorized Official - Last Name:FRESH
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:501-442-2293
Mailing Address - Street 1:1408 S SCHILLER ST
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72202-5817
Mailing Address - Country:US
Mailing Address - Phone:501-507-0675
Mailing Address - Fax:501-421-0107
Practice Address - Street 1:1408 S SCHILLER ST
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72202-5817
Practice Address - Country:US
Practice Address - Phone:501-507-0675
Practice Address - Fax:501-421-0107
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-11
Last Update Date:2020-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No251S00000XAgenciesCommunity/Behavioral Health
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health