Healthcare Provider Details

I. General information

NPI: 1700484169
Provider Name (Legal Business Name): DEBRA JEAN-LAURENT LCDP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/16/2020
Last Update Date: 07/09/2025
Certification Date: 07/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 TOLL GATE RD STE 101C
WARWICK RI
02886-4448
US

IV. Provider business mailing address

300 TOLL GATE RD STE 101C
WARWICK RI
02886-4448
US

V. Phone/Fax

Practice location:
  • Phone: 401-467-0333
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCDP00168
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: