Healthcare Provider Details

I. General information

NPI: 1730343781
Provider Name (Legal Business Name): DAVID E GOULD LCDP,RCS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/17/2008
Last Update Date: 07/17/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2076 WALLUM LAKE RD.
BURRILLVILLE RI
02859-1813
US

IV. Provider business mailing address

2076 WALLUM LAKE RD. PO BOX 398
BURRILLVILLE RI
02859-1813
US

V. Phone/Fax

Practice location:
  • Phone: 401-568-1770
  • Fax: 401-568-3358
Mailing address:
  • Phone: 401-568-1770
  • Fax: 401-568-3358

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberLCDP 00416
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: