Healthcare Provider Details

I. General information

NPI: 1922856400
Provider Name (Legal Business Name): NEW LEAF COUNSELING CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/09/2024
Last Update Date: 12/03/2024
Certification Date: 12/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1130 TEN ROD RD STE F204
NORTH KINGSTOWN RI
02852-4172
US

IV. Provider business mailing address

17 MINGLEWOOD DR
COVENTRY RI
02816-5152
US

V. Phone/Fax

Practice location:
  • Phone: 401-487-1600
  • Fax:
Mailing address:
  • Phone: 401-487-1600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name: MELISSA J GRIFKA
Title or Position: COUNSELOR/ADMIN
Credential: LMFT
Phone: 401-487-1600