Healthcare Provider Details

I. General information

NPI: 1114430907
Provider Name (Legal Business Name): COMPREHENSIVE ADDICTION TREATMENT LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/15/2017
Last Update Date: 11/18/2025
Certification Date: 11/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1950 TOWER HILL RD
N KINGSTOWN RI
02852-6639
US

IV. Provider business mailing address

1950 TOWER HILL RD
NORTH KINGSTOWN RI
02852-6639
US

V. Phone/Fax

Practice location:
  • Phone: 401-559-3954
  • Fax: 401-615-8503
Mailing address:
  • Phone: 401-559-3954
  • Fax: 401-295-2513

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084A0401X
TaxonomyAddiction Medicine (Psychiatry & Neurology) Physician
License NumberMD08308
License Number StateRI

VIII. Authorized Official

Name: MICHAEL C COBURN
Title or Position: OWNER/SOLE PROPRIETOR
Credential:
Phone: 401-559-3954