Healthcare Provider Details

I. General information

NPI: 1003268517
Provider Name (Legal Business Name): ALISHA CHOQUETTE AA, ACDP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/08/2016
Last Update Date: 03/17/2026
Certification Date: 03/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11 NORTH ST
PRESQUE ISLE ME
04769-2296
US

IV. Provider business mailing address

66 BURNETT ST
PROVIDENCE RI
02907-2527
US

V. Phone/Fax

Practice location:
  • Phone: 207-707-3001
  • Fax: 207-707-3000
Mailing address:
  • Phone: 401-785-0050
  • Fax: 401-941-0089

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberLC9327
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: