Provider Demographics
NPI:1285914556
Name:KITCHENS, JESSICA CARRIE (LPC, LADAC, RPT, MAC)
Entity type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:CARRIE
Last Name:KITCHENS
Suffix:
Gender:F
Credentials:LPC, LADAC, RPT, MAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1189 LEELYNJEAN LN
Mailing Address - Street 2:
Mailing Address - City:SPRINGDALE
Mailing Address - State:AR
Mailing Address - Zip Code:72762-0801
Mailing Address - Country:US
Mailing Address - Phone:479-200-0965
Mailing Address - Fax:479-935-9187
Practice Address - Street 1:4210 FRONTAGE RD.
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:AR
Practice Address - Zip Code:72703-5001
Practice Address - Country:US
Practice Address - Phone:479-200-0965
Practice Address - Fax:479-935-9187
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-18
Last Update Date:2017-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X
ARP1206062101YP2500X
AR347L101YA0400X
VA508408101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)