Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YA0400X | Addiction Counselor (Substance Use Disorder) | CDP00563 | RI |
NPI | 1003298183 |
---|---|
Provider Name | Colleen Thompson |
First Address | Narragansett, RI 02882-3237 |
Second Address | Narragansett, RI 02882-3237 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/06/2015 |
Last Update Date | 24/06/2015 |