Individual
ROOSEVELT DALE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
806 GREENVILLE AVE, JOHNSTON, RI 02919-1305
(401) 516-1314
Mailing address
806 GREENVILLE AVE, JOHNSTON, RI 02919-1305
(401) 516-1314
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
CDP01081
RI
172V00000X
Community Health Worker
201835
RI
Other
Enumeration date
09/29/2025
Last updated
12/25/2025
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