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General NPI Number Information
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NPI Number | 1114436847
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Entity Type | Organization
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Legal Business Name | TAKE CARE COUNSELING
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Dates
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Enumeration Date | 09/26/2017
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Last Update Date | 09/26/2017
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Provider Practice Location Address
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Address Line | 193 CANAL ST
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City | WESTERLY
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State | RI
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Zip | 02891-1556
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Country | US
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Telephone | 401-500-5458
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Fax |
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Provider Business Mailing Address
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Address Line | 193 CANAL ST
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City | WESTERLY
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State | RI
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Zip | 02891-1556
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | BRENDA MEDINA
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Credential | LICSW
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Telephone | 401-500-5458
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | ISW02428
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License Number State | RI
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