Individual
KIM MARIE GONZAGA
Active
Sole proprietor
No
Provider details
NPI number
Gender
X
Credential
LCDP
Contact information
Practice address
4705 OLD POST RD, CHARLESTOWN, RI 02813-1841
(401) 364-7705
(401) 364-1982
Mailing address
117 ELLENFIELD ST STE 101, PROVIDENCE, RI 02905-4541
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
CDP01032
RI
Other
Enumeration date
03/24/2025
Last updated
05/16/2025
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