Individual
NOLA LASALLE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LMHC, LCDP
Contact information
Practice address
1070 MAIN ST, PAWTUCKET, RI 02860-4847
(401) 727-6400
Mailing address
528 N MAIN ST, PROVIDENCE, RI 02904-5757
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
MHC00162
RI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
30702-6
BLUE CROSS
RI
01
—
408940
BLUE CHIP
RI
01
—
62-54321
UNITED BEHAVIORAL HEALTH
RI
05
—
NL34699
—
RI
Enumeration date
07/16/2006
Last updated
07/08/2008
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