| Doctor Name: | MARC PAINE |
| NPI Number: | 1467806505 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | M.DIV., M.S., LAC |
| License Number: | A1603038 |
| Business Practice Address: | 5 Tillicoultry Ln Bella Vista, AR - 727154732 |
| Business Phone Number: | 4792764883 |
| Business Fax Number: | |
| Mailing Address: | 5 Tillicoultry Ln, BELLA VISTA |
| State: | AR |
| Postal Code: | 727154732 |
| Phone Number: | |
| Fax Number: | |
| NPI Enumeration Date: | 04/14/2016 |
| NPI Last Update Date: | 05/26/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YP2500X |
| License Number: | A1603038 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | AR |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Professional |
| Taxonomy Definition: | |