Provider Demographics
NPI:1720855240
Name:WELLNESS CENTER OF ARKANSAS LLC
Entity Type:Organization
Organization Name:WELLNESS CENTER OF ARKANSAS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHARIS
Authorized Official - Middle Name:
Authorized Official - Last Name:MIAN
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:501-722-3578
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:72022-7202
Practice Address - Country:US
Practice Address - Phone:501-722-3578
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-12-05
Last Update Date:2023-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty