Provider Demographics
NPI:1245014877
Name:DAVA L BROCK LPC PLLC
Entity type:Organization
Organization Name:DAVA L BROCK LPC PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CHRIS
Authorized Official - Middle Name:
Authorized Official - Last Name:FOSTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:844-514-5183
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-23
Last Update Date:2023-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty