Provider Demographics
NPI:1851475701
Name:DE ROECK, CARA KRIEHN (LPC LPE)
Entity type:Individual
Prefix:MS
First Name:CARA
Middle Name:KRIEHN
Last Name:DE ROECK
Suffix:
Gender:F
Credentials:LPC LPE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:308 W MONROE AVE
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:AR
Mailing Address - Zip Code:72401-2741
Mailing Address - Country:US
Mailing Address - Phone:870-972-4770
Mailing Address - Fax:870-972-4774
Practice Address - Street 1:308 W MONROE AVE
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:AR
Practice Address - Zip Code:72401-2741
Practice Address - Country:US
Practice Address - Phone:870-972-4770
Practice Address - Fax:870-972-4774
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
174400000X
ARP9504014101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered174400000XOther Service ProvidersSpecialist
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional