Individual
KAILAH L TIDWELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LAC
Contact information
Practice address
323 CENTER ST STE 1401, LITTLE ROCK, AR 72201-2644
(501) 412-5327
(501) 374-2420
Mailing address
323 CENTER ST STE 1401, LITTLE ROCK, AR 72201-2644
(501) 412-5327
(501) 374-2420
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
A1809124
AR
Other
Enumeration date
08/17/2021
Last updated
08/17/2021
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