Individual
MRS. STACIE LYN SOUZA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LICSW
Contact information
Practice address
830 CHALKSTONE AVE, PROVIDENCE, RI 02908-4734
(401) 273-7100
Mailing address
12 LITTLE JOHN LN, WEST WARWICK, RI 02893-5593
(401) 273-7100
(401) 525-2527
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
CSW00735
RI
Other
Enumeration date
08/30/2006
Last updated
07/08/2007
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