Provider Demographics
NPI:1457707457
Name:MIAN, CHARIS (LPC, NCC, SCM, STAC)
Entity Type:Individual
Prefix:
First Name:CHARIS
Middle Name:
Last Name:MIAN
Suffix:
Gender:F
Credentials:LPC, NCC, SCM, STAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:207 PROGRESS WAY
Mailing Address - Street 2:SUITE 105
Mailing Address - City:BRYANT
Mailing Address - State:AR
Mailing Address - Zip Code:72022-3578
Mailing Address - Country:US
Mailing Address - Phone:501-722-3578
Mailing Address - Fax:
Practice Address - Street 1:207 PROGRESS WAY
Practice Address - Street 2:SUITE 105
Practice Address - City:BRYANT
Practice Address - State:AR
Practice Address - Zip Code:72022
Practice Address - Country:US
Practice Address - Phone:501-722-3578
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-05-09
Last Update Date:2023-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARP1810140101Y00000X, 101YP2500X
ARA1604046101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor