Individual
BEVERLY FAIRHURST
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.A., LCMHC, LCDP
Contact information
Practice address
610 WAMPANOAG TRL, EAST PROVIDENCE, RI 02915-1504
(401) 431-9870
(401) 435-7486
Mailing address
7 ROCCO AVE, PAWTUCKET, RI 02860-5822
(401) 725-2278
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
00027
RI
101YM0800X
Mental Health Counselor
Primary
80
RI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
30016-6
BLUE CROSS
RI
01
—
406396
BLUE CHIP
RI
01
—
62-34366
UNITED
RI
05
—
BF15322
—
RI
Enumeration date
12/07/2005
Last updated
09/11/2025
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