Provider Demographics
NPI:1699145623
Name:SUCHOMELLY, FAITH MARY CATHERINE (LAC)
Entity type:Individual
Prefix:
First Name:FAITH
Middle Name:MARY CATHERINE
Last Name:SUCHOMELLY
Suffix:
Gender:
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 11064
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72703-1001
Mailing Address - Country:US
Mailing Address - Phone:870-520-5014
Mailing Address - Fax:
Practice Address - Street 1:3305 E HIGHLAND DR STE B
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:AR
Practice Address - Zip Code:72401-6491
Practice Address - Country:US
Practice Address - Phone:870-520-5014
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-10-02
Last Update Date:2025-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health