Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YA0400X | Addiction Counselor (Substance Use Disorder) | LCDP00106 | RI |
NPI | 1003192444 |
---|---|
Provider Name | David Michael Thatcher |
First Address | Woonsocket, RI 02895-3247 |
Second Address | Woonsocket, RI 02895-3247 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/10/2011 |
Last Update Date | 31/10/2011 |