Healthcare Provider Details

I. General information

NPI: 1285425579
Provider Name (Legal Business Name): DOUGLAS SHEHAN LCDP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/15/2025
Last Update Date: 05/15/2025
Certification Date: 05/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1020 PARK AVE
CRANSTON RI
02910-3227
US

IV. Provider business mailing address

1020 PARK AVE
CRANSTON RI
02910-3227
US

V. Phone/Fax

Practice location:
  • Phone: 401-396-7649
  • Fax:
Mailing address:
  • Phone: 401-396-7649
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: