is a Addiction (substance Use Disorder) in Pascoag, Rhode Island. practices all healthcare services and medical treatments related to Addiction (substance Use Disorder). The NPI Number for is 1699985226. The last update date is .
's current location address is 2198 Wallum Lake Rd., Pascoag, Rhode Island. You can contact this provider via phone number 4015685284. The mailing address for is 2198 Wallum Lake Rd., Pascoag, Rhode Island. To know further, please read the information below!
Provider Profile Detail
| Provider Name | |
|---|---|
| Address | 2198 Wallum Lake Rd., Pascoag, Rhode Island |
| Phone Number | 4015685284 |
| Fax Number | |
| Sole Proprietor | -- |
| Credentials | -- |
NPI Number Detail
| NPI Number | 1699985226 |
|---|---|
| Provider Enumeration Date | |
| Last Updated Date |
Provider Mailing Address Detail
| Address | 2198 Wallum Lake Rd. |
|---|---|
| City | Pascoag |
| State | Rhode Island (RI) |
| Post Code | 2859 |
| Phone Number | 4015685284 |
| Fax Number |
Provider's Primary Taxonomy Detail
| Speciality | Addiction (substance Use Disorder) |
|---|---|
| Taxonomy | 101Ya0400X |
| Licence No | LCDP00152 |
|
Definition: A counselor who helps people with alcohol, drug, gambling, internet, and other types of addictions. |
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Provider's Other Legacy Identifiers
| Identifier | Identifier Type | Identifier State | Identifier Issuer |
|---|---|---|---|
| DW66813 | RI | -- |
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