Individual
COURTNEY BACON-LATINA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPC
Contact information
Practice address
829 HALBERT ST, MALVERN, AR 72104-2607
(501) 332-4400
(501) 332-4403
Mailing address
829 HALBERT ST, MALVERN, AR 72104-2607
(501) 332-4400
(501) 332-4403
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
P2203015
AR
Other
Enumeration date
10/04/2019
Last updated
04/01/2022
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