ACTIVELIFE COUNSELING, LLC (NPI# 1053918169) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1053918169 |
| Entity Type | Organization |
| Organization Name | ACTIVELIFE COUNSELING, LLC |
| Practice Address |
1792 E Joyce Blvd Ste 105 Fayetteville AR 72703-5253 |
| Practice Telephone | 4793587690 |
| Mailing Telephone | 4793587690 |
| Enumeration Date | 2020-10-02 |
| Last Update Date | 2020-10-02 |
| Authorized Official Name | RACHEL HENNINGSEN (OWNER, FOUNDER, CEO, COUNSELOR) |
| Authorized Official Telephone | 5014138221 |
| Authorized Official Credential | LAC, MS, EDS |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 1041C0700X |
Social Worker Specialization: Clinical |
Behavioral Health & Social Service Providers | ||
| N | 101YP2500X |
Counselor Specialization: Professional |
Behavioral Health & Social Service Providers | ||
| Y | 261QM0801X |
Clinic/Center Specialization: Mental Health (Including Community Mental Health Center) |
Ambulatory Health Care Facilities |
| Street Address |
1792 E JOYCE BLVD STE 105 |
| City | FAYETTEVILLE |
| State | AR |
| Zip Code | 72703-5253 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1700485661 | Kelsi Mcbrayer Godwin | Social Worker | 1792 E Joyce Blvd Ste 105, Fayetteville, AR 72703-5253 | 2020-10-21 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1477154391 | Margaret Sorrells | Pharmacist | 3909 N Mall Ave Attn:pharmacy, Fayetteville, AR 72703 | 2020-11-06 |
| 1497369631 | Justin A Rand | Massage Therapist | 88 W Colt Square Dr, Fayetteville, Ar 72703, Fayetteville, AR 72703 | 2020-09-04 |
| 1235777558 | Washington Regional Medical System | Specialist | 3264 N North Hills Blvd, Fayetteville, AR 72703 | 2019-12-17 |
| 1760024582 | Haley Brooke Thompson | Occupational Therapist | 2474 E Joyce Blvd Ste 2, Null, Fayetteville, AR 72703 | 2019-10-14 |
| 1306492129 | Bhg L, LLC | Clinic/Center | 8 Colt Square Drive, Fayetteville, AR 72703 | 2019-08-16 |
| 1306406269 | Idell Marie Mitchell | Optometrist | Eye Clinic, 1100 N College Ave, Fayetteville, AR 72703 | 2019-06-13 |
| 1821574815 | Toni Myer | Nurse Practitioner | 3 E Appleby Rd Ste 101, Fayetteville, AR 72703 | 2018-07-13 |
| 1306340393 | Josh Kelfer | Student in an Organized Health Care Education/Training Program | 1125 North College Avenue, Fayetteville, AR 72703 | 2018-03-22 |
| 1649726449 | Vantage Point of Nwa | Community/Behavioral Health | 4171 N. Crossover Rd, Fayetteville, AR 72703 | 2016-08-31 |
| 1386097137 | Jason Nordstrom | Speech-Language Pathologist | 2664 N Valencia Ave, Fayetteville, AR 72703 | 2016-07-18 |
| Find all providers in zip 72703 | ||||
| Taxonomy Code | 261QM0801X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Mental Health (Including Community Mental Health Center) |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1306492129 | Bhg L, LLC | Clinic/Center | 8 Colt Square Drive, Fayetteville, AR 72703 | 2019-08-16 |
| 1538621602 | A New Beginning for Families Inc | Clinic/Center | 500 Lanier Ave W Ste Aoffice7, Fayetteville, GA 30214-7636 | 2019-04-05 |
| 1386920049 | Point Momentum, P.l.l.c. | Clinic/Center | 4257 Gabel Drive, Fayetteville, AR 72703 | 2011-10-26 |
| 1669606448 | Sunrise Specialty Clinic | Clinic/Center | 709 Hay St, Fayetteville, NC 28301-5423 | 2009-05-08 |
| 1073647392 | Professional Family Care Services, Inc. | Clinic/Center | 350 Wagoner Dr, Suite 103, Fayetteville, NC 28303-4678 | 2007-03-16 |
| 1811032022 | S & T Wecare Community Support | Clinic/Center | 401 Offing Dr, Fayetteville, NC 28314-1043 | 2007-02-21 |
| 1063564003 | Unity Home Care, Inc | Clinic/Center | 211 Fairway Dr, Suite, Fayetteville, NC 28305-5571 | 2007-01-18 |
| 1104882547 | Northwest Counseling & Social Work Services, Inc | Clinic/Center | 111 E Davidson St, Fayetteville, AR 72701-3413 | 2006-04-25 |
| 1558978858 | Day By Day: A Center for Health and Healing | Clinic/Center | 215 N East Ave Ste 102, Fayetteville, AR 72701-5296 | 2020-09-30 |
| 1609482439 | Centerstone of Tennesse Inc. | Clinic/Center | 3505 Village Dr, Fayetteville, NC 28304-4513 | 2020-09-17 |
| Find all providers in FAYETTEVILLE | ||||
| City | FAYETTEVILLE |
| Zip Code | 72703 |
Please comment or provide details below to improve the information on ACTIVELIFE COUNSELING, LLC.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.