Healthcare Provider Details

I. General information

NPI: 1376892679
Provider Name (Legal Business Name): THE CENTER FOR CHANGE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2012
Last Update Date: 09/27/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1045 WARWICK AVE SUITE 101
WARWICK RI
02888-3665
US

IV. Provider business mailing address

1045 WARWICK AVE SUITE 101
WARWICK RI
02888-3665
US

V. Phone/Fax

Practice location:
  • Phone: 401-465-2670
  • Fax: 401-270-0660
Mailing address:
  • Phone: 401-465-2670
  • Fax: 401-270-0660

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: DR. KRISTIN A DAVID
Title or Position: LICENSED CLINICAL PSYCHOLOGIST
Credential: PSY.D.
Phone: 401-465-2670