Healthcare Provider Details

I. General information

NPI: 1356264030
Provider Name (Legal Business Name): COUNTESS WELLNESS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/31/2026
Last Update Date: 07/31/2026
Certification Date: 07/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16 GLASGOW ST APT A
PROVIDENCE RI
02908-1711
US

IV. Provider business mailing address

PO BOX 28866
PROVIDENCE RI
02908-0866
US

V. Phone/Fax

Practice location:
  • Phone: 401-855-1241
  • Fax:
Mailing address:
  • Phone: 401-855-1241
  • Fax: 401-855-1241

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: CONTESSA BROWN
Title or Position: LMHC
Credential: LMHC
Phone: 401-855-1241