Healthcare Provider Details

I. General information

NPI: 1114555489
Provider Name (Legal Business Name): MICHELLE MARIE O'ROURKE LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/31/2020
Last Update Date: 08/27/2026
Certification Date: 08/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7 AUSTIN AVE
GREENVILLE RI
02828-1520
US

IV. Provider business mailing address

530 N MAIN ST
PROVIDENCE RI
02904-5762
US

V. Phone/Fax

Practice location:
  • Phone: 401-349-3131
  • Fax:
Mailing address:
  • Phone: 401-276-4100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMHC02007
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: