Healthcare Provider Details

I. General information

NPI: 1588672810
Provider Name (Legal Business Name): ELISA D REID MA, LCDP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ELISA D REID MA, LCDP

II. Dates (important events)

Enumeration Date: 08/03/2006
Last Update Date: 04/24/2026
Certification Date: 04/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 DIAMOND HILL RD STE 18
WOONSOCKET RI
02895-1554
US

IV. Provider business mailing address

PO BOX 746088
ATLANTA GA
30374-6088
US

V. Phone/Fax

Practice location:
  • Phone: 401-470-7116
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberLCDP00292
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: