Organization
IMPACT COUNSELING CLINIC, INCORPORATED
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. PRISCILLA ANN FAULKNER LPC (CEO)
(870) 285-1413
Entity
Organization
Contact information
Practice address
1124 MAIN AVE, DIERKS, AR 71833-9421
(870) 285-1413
(870) 825-2060
Mailing address
PO BOX 575, DIERKS, AR 71833-0575
(870) 285-1413
(870) 825-2060
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
—
—
261QM0850X
Adult Mental Health Clinic/Center
—
—
261QM0855X
Adolescent and Children Mental Health Clinic/Center
Primary
—
—
Other
Enumeration date
10/27/2016
Last updated
08/20/2021
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