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General NPI Number Information
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NPI Number | 1245617422
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Entity Type | Organization
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Legal Business Name | WHITESTONE LIFE CENTER INC
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Dates
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Enumeration Date | 04/27/2015
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Last Update Date | 04/27/2015
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Provider Practice Location Address
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Address Line | 475 CRANSTON ST
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City | PROVIDENCE
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State | RI
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Zip | 02907-2744
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Country | US
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Telephone | 401-523-7520
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Fax |
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Provider Business Mailing Address
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Address Line | 475 CRANSTON ST
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City | PROVIDENCE
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State | RI
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Zip | 02907-2744
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Country | US
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Telephone | 401-523-7520
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Fax |
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Authorized Official
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Title or Position | SUBSTANCE ABUSE THERAPIST
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Name | HERMAN J FALU JR.
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Credential | LCDP LCDS
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Telephone | 401-523-7520
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP1600X
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Taxonomy Name | Pastoral Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number |
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License Number State |
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