Organization
PHOENIX HOUSE OF NEW ENGLAND
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. REYNARD LORIN BULLOCK MS LMFT (COUNSELOR)
(401) 783-0782
Entity
Organization
Contact information
Practice address
1058 KINGSTOWN RD, WAKEFIELD, RI 02879-2487
(401) 783-0782
(401) 783-1154
Mailing address
1058 KINGSTOWN RD, WAKEFIELD, RI 02879-2487
(401) 783-0782
(401) 783-1154
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
00100
RI
Other
Enumeration date
03/28/2007
Last updated
08/22/2020
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