Provider Demographics
NPI:1366955346
Name:PINE BLUFF COUNSELING GROUP, PLLC
Entity type:Organization
Organization Name:PINE BLUFF COUNSELING GROUP, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CAREY
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:DOBBINS
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:501-733-5413
Mailing Address - Street 1:2106 E 6TH AVE
Mailing Address - Street 2:
Mailing Address - City:PINE BLUFF
Mailing Address - State:AR
Mailing Address - Zip Code:71601-5402
Mailing Address - Country:US
Mailing Address - Phone:501-733-5413
Mailing Address - Fax:
Practice Address - Street 1:3104 S CATALPA ST STE 5
Practice Address - Street 2:
Practice Address - City:PINE BLUFF
Practice Address - State:AR
Practice Address - Zip Code:71603-4869
Practice Address - Country:US
Practice Address - Phone:501-733-5413
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-13
Last Update Date:2025-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR7090-C1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1144501503OtherNPI NUMBER
AR7090-COtherLICENSE NUMBER