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General NPI Number Information
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NPI Number | 1679894521
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Entity Type | Organization
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Legal Business Name | PSYCHOTHERAPY CENTER FOR WELLNESS, LLC
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Dates
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Enumeration Date | 06/15/2010
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Last Update Date | 06/15/2010
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Provider Practice Location Address
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Address Line | 267 MAIN ST
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City | EAST GREENWICH
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State | RI
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Zip | 02818-3750
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Country | US
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Telephone | 401-536-5575
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Fax |
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Provider Business Mailing Address
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Address Line | 114 TURNER AVE
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City | CRANSTON
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State | RI
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Zip | 02920-2740
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Country | US
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Telephone | 401-536-5575
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MS. EMILY J VOLDEN
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Credential | LICSW
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Telephone | 401-536-5575
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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 | ISW01901
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License Number State | RI
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