Organization
NWA PREMIER THERAPY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. VICTORIA LYNN SULLIVAN LPC (OWNER)
(479) 372-7446
Entity
Organization
Contact information
Practice address
5305 W VILLAGE PKWY, SUITE 8, ROGERS, AR 72758
(479) 372-7446
Mailing address
5305 W VILLAGE PKWY, SUITE 8, ROGERS, AR 72758
(479) 372-7446
Taxonomy
Speciality
Code
Description
License number
State
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
P0304018
—
AR
Enumeration date
01/29/2019
Last updated
01/29/2019
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