Healthcare Provider Details

I. General information

NPI: 1477100808
Provider Name (Legal Business Name): RAISA EMILIA GARCIA-DIAZ LMHC-A
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/21/2019
Last Update Date: 06/17/2026
Certification Date: 06/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 TOLL GATE RD STE 300
WARWICK RI
02886-4416
US

IV. Provider business mailing address

300 TOLL GATE RD STE 300
WARWICK RI
02886-4416
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMHC00512-A
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: