Healthcare Provider Details

I. General information

NPI: 1831948090
Provider Name (Legal Business Name): TRANQUIL WELLNESS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/17/2024
Last Update Date: 04/14/2026
Certification Date: 04/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 BALD HILL RD
WARWICK RI
02886-1617
US

IV. Provider business mailing address

1643 WARWICK AVE
WARWICK RI
02889-1525
US

V. Phone/Fax

Practice location:
  • Phone: 508-965-8769
  • Fax:
Mailing address:
  • Phone: 508-965-8769
  • Fax:

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: CHRISTOPHER DESROCHES
Title or Position: OWNER
Credential: LMHC
Phone: 508-965-8769