Healthcare Provider Details

I. General information

NPI: 1558230607
Provider Name (Legal Business Name): KPUMA COUNSELING & CONSULTING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/05/2025
Last Update Date: 12/21/2025
Certification Date: 12/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1635 MINERAL SPRING AVE STE 202
NORTH PROVIDENCE RI
02904-4025
US

IV. Provider business mailing address

95 LYNCH ST
PROVIDENCE RI
02908-5107
US

V. Phone/Fax

Practice location:
  • Phone: 104-663-8962
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: WILLIE BORKAI
Title or Position: OWNER
Credential: LMHC
Phone: 401-663-8962