Organization
CHILDREN IN BALANCE PSYCHOLOGICAL ASSOCIATES LLC
Active
Other names
Center For Self Care CSC
Organization subpart
No
Provider details
NPI number
Authorized official
MISS TIFFANY BOURQUIN LMHC (CEO/EXECUTIVE DIRECTOR)
(508) 962-7364
Entity
Organization
Contact information
Practice address
575 E MAIN RD, 4, MIDDLETOWN, RI 02842-5528
(508) 962-7364
(401) 619-7766
Mailing address
P.O. BOX 577, SOMERSET, MA 02726
(508) 962-7364
(401) 619-7766
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
00547
RI
101YM0800X
Mental Health Counselor
6722
MA
101YM0800X
Mental Health Counselor
7566
MA
101YM0800X
Mental Health Counselor
7566
RI
1041C0700X
Clinical Social Worker
02472
RI
1041C0700X
Clinical Social Worker
CSW01724
RI
251S00000X
Community/Behavioral Health Agency
7566
MA
251S00000X
Community/Behavioral Health Agency
MHC00502
RI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1669631487
INDIVIDUAL NPI 1669631487
—
05
—
BH90286
—
RI
Enumeration date
09/19/2012
Last updated
04/26/2017
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