# IMPACT COUNSELING CLINIC, INCORPORATED

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1205388071
- **Authorized official:** MRS. PRISCILLA ANN FAULKNER LPC (CEO)
- **Authorized official phone:** (870) 285-1413

## Contact information

- **Practice address:** 1124 MAIN AVE, DIERKS, AR 71833-9421
- **Practice address phone:** (870) 285-1413
- **Practice address fax:** (870) 825-2060
- **Mailing address:** PO BOX 575, DIERKS, AR 71833-0575
- **Mailing address phone:** (870) 285-1413
- **Mailing address fax:** (870) 825-2060

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 101YM0800X | Mental Health Counselor | — | NULL | — |
| 101YM0800X | Mental Health Counselor | — | — | — |
| 261QM0850X | Adult Mental Health Clinic/Center | — | NULL | — |
| 261QM0855X | Adolescent and Children Mental Health Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 10/27/2016
- **Last updated:** 08/20/2021