Healthcare Provider Details

I. General information

NPI: 1982451969
Provider Name (Legal Business Name): RYAN MITCHELL ASADORIAN LCDP, LMHC-A
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/06/2024
Last Update Date: 06/05/2026
Certification Date: 06/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1020 PARK AVE
CRANSTON RI
02910-3227
US

IV. Provider business mailing address

20 GRANT DR
COVENTRY RI
02816-4304
US

V. Phone/Fax

Practice location:
  • Phone: 401-396-7649
  • Fax:
Mailing address:
  • Phone: 401-378-4097
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCDP01100
License Number StateRI
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMHC00143-A
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: