Healthcare Provider Details

I. General information

NPI: 1033476163
Provider Name (Legal Business Name): LISA L LANGLOIS LCDP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/13/2012
Last Update Date: 07/17/2025
Certification Date: 07/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1052 PARK AVE
CRANSTON RI
02910-3225
US

IV. Provider business mailing address

528 N MAIN ST
PROVIDENCE RI
02904-5757
US

V. Phone/Fax

Practice location:
  • Phone: 401-461-5056
  • Fax: 401-275-5056
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCDP00518
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: