Provider Demographics
NPI:1457594848
Name:FAULKNER, PRISCILLA ANN (LPC)
Entity Type:Individual
Prefix:
First Name:PRISCILLA
Middle Name:ANN
Last Name:FAULKNER
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:PO BOX 575
Mailing Address - Street 2:
Mailing Address - City:DIERKS
Mailing Address - State:AR
Mailing Address - Zip Code:71833-0575
Mailing Address - Country:US
Mailing Address - Phone:870-285-1413
Mailing Address - Fax:870-230-8201
Practice Address - Street 1:1124 MAIN AVE
Practice Address - Street 2:
Practice Address - City:DIERKS
Practice Address - State:AR
Practice Address - Zip Code:71833-9421
Practice Address - Country:US
Practice Address - Phone:187-028-5141
Practice Address - Fax:870-825-2060
Is Sole Proprietor?:No
Enumeration Date:2009-04-14
Last Update Date:2021-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA1003032101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health