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1720763717
JACKSON LAKE
LITTLE ROCK, AR
NPI
1720763717
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
Yes
Primary Taxonomy
101YM0800X Counselor Mental Health
(Licence: AR A2305013)
Enumeration Date
2023-06-19
Last Update Date
2023-06-19
Business Address
JACKSON LAKE LAC
10020 N RODNEY PARHAM RD STE G
LITTLE ROCK, AR 72227-5588
Phone number: 501-831-4314
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Mailing Address
JACKSON LAKE LAC
10020 N RODNEY PARHAM RD STE G
LITTLE ROCK, AR 72227-5588
Phone number:
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