Provider Demographics
NPI:1912664228
Name:VARNADORE, ADRIAN LEIGH (LAC)
Entity Type:Individual
Prefix:
First Name:ADRIAN
Middle Name:LEIGH
Last Name:VARNADORE
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1301 N PRAIRIE DUNES TRL APT 205
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72704-6440
Mailing Address - Country:US
Mailing Address - Phone:870-718-5663
Mailing Address - Fax:
Practice Address - Street 1:34 W COLT SQUARE DR STE 3
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:AR
Practice Address - Zip Code:72703-2888
Practice Address - Country:US
Practice Address - Phone:479-535-0333
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-22
Last Update Date:2021-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA2109025101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health