Individual
JESSICA ELLIOTT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MA, CAGS, LCDP
Contact information
Practice address
1052 PARK AVE, CRANSTON, RI 02910-3225
(401) 714-9526
Mailing address
1052 PARK AVE, CRANSTON, RI 02910-3225
(401) 714-9526
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
CDP00462
RI
Other
Enumeration date
11/19/2014
Last updated
11/19/2014
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