Healthcare Provider Details

I. General information

NPI: 1215867247
Provider Name (Legal Business Name): GODS OWN HOLISTIC BEHAVIORAL COUNSELING PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/21/2026
Last Update Date: 05/21/2026
Certification Date: 05/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

32 WENDELL ST
PAWTUCKET RI
02861-1245
US

IV. Provider business mailing address

356 PROSPECT ST
BROCKTON MA
02301-3368
US

V. Phone/Fax

Practice location:
  • Phone: 617-217-8255
  • Fax:
Mailing address:
  • Phone: 617-217-8255
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: DORCAS ADENIYI
Title or Position: OWNER
Credential:
Phone: 315-547-0502