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General NPI Number Information
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NPI Number | 1861734063
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Entity Type | Individual
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Provider Name | LANCE C MCCORMACK LCDP
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Gender | Male
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Dates
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Enumeration Date | 03/26/2013
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Last Update Date | 03/26/2013
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Provider Practice Location Address
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Address Line | 1845 POST RD. SUITE #10N
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City | WARWICK
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State | RI
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Zip | 02886
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Country | US
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Telephone | 401-737-4685
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Fax |
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Provider Business Mailing Address
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Address Line | 1845 POST RD. SUITE #10N
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City | WARWICK
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State | RI
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Zip | 02886
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Country | US
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Telephone | 401-737-4685
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | CDP00439
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License Number State | RI
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