Provider Demographics
NPI:1003119751
Name:STATE OF THE HEART COUNSELING SERVICES, INC.
Entity type:Organization
Organization Name:STATE OF THE HEART COUNSELING SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANDREA
Authorized Official - Middle Name:MICHELLE
Authorized Official - Last Name:FRESH
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:501-442-2293
Mailing Address - Street 1:PO BOX 451
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72203-0451
Mailing Address - Country:US
Mailing Address - Phone:501-442-2293
Mailing Address - Fax:
Practice Address - Street 1:7123 I-30
Practice Address - Street 2:SUITE 6
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72209-3121
Practice Address - Country:US
Practice Address - Phone:501-414-0070
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-17
Last Update Date:2012-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR2117-C101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty