Healthcare Provider Details

I. General information

NPI: 1003532417
Provider Name (Legal Business Name): CULTIVATING MINDS COUNSELING SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/17/2022
Last Update Date: 10/17/2022
Certification Date: 10/17/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23 NORTH RD STE A24
PEACE DALE RI
02879-8131
US

IV. Provider business mailing address

23 NORTH RD STE A24
PEACE DALE RI
02879-8131
US

V. Phone/Fax

Practice location:
  • Phone: 401-360-6204
  • Fax:
Mailing address:
  • Phone: 401-360-6204
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: CARA BERMAN
Title or Position: OWNER
Credential: LMHC
Phone: 401-360-6204