04D2175834 CLIA NUMBER - FAYETTEVILLE PSYCHIATRY

Laboratory Demographics

  • CLIA Code: 04D2175834
  • Facility Name: FAYETTEVILLE PSYCHIATRY
  • Facility Address: 205 N COLLEGE AVE
    FAYETTEVILLE, AR
    ZIP 72701
  • Facility Phone: 479 422-5163
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: DR. ADRIANA U. STACEY
  • NPI Number: 1093298929
  • Taxonomy: 235Z00000X - Speech-Language Pathologist

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CLIA Record

Field Name Field Value
CLIA Number 04D2175834
LAB Type Physician Office
Facility Name FAYETTEVILLE PSYCHIATRY
Street 205 N COLLEGE AVE
City FAYETTEVILLE
State AR
ZIP 72701
Phone 479 422-5163
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 12/3/2023
Certificate Expiration Date 12/2/2025
Facility Type Physician Office
Lab Director DR. ADRIANA U. STACEY

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This page was last updated on: 9/29/2025