Healthcare Provider Details

I. General information

NPI: 1295446243
Provider Name (Legal Business Name): COURTNEY ROSE THREATS LICSW, AADC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/12/2022
Last Update Date: 01/31/2024
Certification Date: 12/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3 WHISPERING PINES CT
WEST WARWICK RI
02893-5586
US

IV. Provider business mailing address

3 WHISPERING PINES CT
WEST WARWICK RI
02893-5586
US

V. Phone/Fax

Practice location:
  • Phone: 401-854-8334
  • Fax:
Mailing address:
  • Phone: 401-854-8334
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCPD00969
License Number StateRI
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberCSW01753
License Number StateRI
# 3
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberISW04025
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: