Provider Demographics
NPI:1316127301
Name:DRIVER, THERESA JANE (LPC)
Entity type:Individual
Prefix:
First Name:THERESA
Middle Name:JANE
Last Name:DRIVER
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:60 E TOWNSHIP ST STE 9
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72703-2836
Mailing Address - Country:US
Mailing Address - Phone:479-263-2271
Mailing Address - Fax:
Practice Address - Street 1:60 E TOWNSHIP ST STE 9
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:AR
Practice Address - Zip Code:72703-2836
Practice Address - Country:US
Practice Address - Phone:479-263-2271
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-11-07
Last Update Date:2013-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARP1311108101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional