04D2215047 CLIA NUMBER - LIVING HOPE SOUTHEAST, LLC

Laboratory Demographics

  • CLIA Code: 04D2215047
  • Facility Name: LIVING HOPE SOUTHEAST, LLC
  • Facility Address: 10025 W MARKHAM STREET, STE 150
    LITTLE ROCK, AR
    ZIP 72205
  • Facility Phone: 501 663-5473
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: DR. KENNETH STEPHENS
  • NPI Number: 1689877862
  • Taxonomy: 101YM0800X - Counselor

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CLIA Record

Field Name Field Value
CLIA Number 04D2215047
LAB Type Physician Office
Facility Name LIVING HOPE SOUTHEAST, LLC
Street 10025 W MARKHAM STREET, STE 150
City LITTLE ROCK
State AR
ZIP 72205
Phone 501 663-5473
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 2/26/2025
Certificate Expiration Date 2/25/2027
Facility Type Physician Office
Lab Director DR. KENNETH STEPHENS

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