=====================================================
General NPI Number Information
=====================================================
NPI Number | 1659049898
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ADDICTION RECOVERY COUNSELING, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/02/2021
-----------------------------------------------------
Last Update Date | 09/02/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 360 FAUNCE CORNER RD UNIT 5
-----------------------------------------------------
City | DARTMOUTH
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 02747
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 508-938-9646
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 360 FAUNCE CORNER RD UNIT 5
-----------------------------------------------------
City | DARTMOUTH
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 02747
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 774-201-9304
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER, SUBSTANCE ABUSE COUNSELOR
-----------------------------------------------------
Name | MS. TANYA LEE GOUVEIA
-----------------------------------------------------
Credential | MA, MPA, LADC-I, LCD
-----------------------------------------------------
Telephone | 508-938-9646
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YA0400X
-----------------------------------------------------
Taxonomy Name | Addiction (Substance Use Disorder) Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------