Healthcare Provider Details

I. General information

NPI: 1265594220
Provider Name (Legal Business Name): ROBERT WILSON HUXTABLE L.M.H.C., L.C.D.P.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/15/2006
Last Update Date: 06/26/2025
Certification Date: 06/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

186 PROVIDENCE ST
WEST WARWICK RI
02893-2508
US

IV. Provider business mailing address

186 PROVIDENCE ST
WEST WARWICK RI
02893-2508
US

V. Phone/Fax

Practice location:
  • Phone: 401-767-4100
  • Fax: 401-235-6833
Mailing address:
  • Phone: 401-767-4100
  • Fax: 401-235-6833

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number00264
License Number StateRI
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMHC00147
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: