Healthcare Provider Details

I. General information

NPI: 1215529524
Provider Name (Legal Business Name): HARVEST HOPE COUNSELING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/08/2021
Last Update Date: 07/19/2021
Certification Date: 07/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 RICHMOND SQ STE 141C
PROVIDENCE RI
02906-5140
US

IV. Provider business mailing address

1 RICHMOND SQ STE 141C
PROVIDENCE RI
02906-5140
US

V. Phone/Fax

Practice location:
  • Phone: 401-516-4603
  • Fax:
Mailing address:
  • Phone: 401-516-4603
  • Fax: 401-696-8389

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name: SHAUNA MCCAFFERTY
Title or Position: CLINICAL SOCIAL WORKER
Credential: MSW, LICSW, ACSW
Phone: 401-516-4603