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General NPI Number Information
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NPI Number | 1952993438
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Entity Type | Organization
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Legal Business Name | NORTHEAST SUBSTANCE ABUSE PROFESSIONALS, LLC
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Dates
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Enumeration Date | 02/06/2021
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Last Update Date | 02/18/2021
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Provider Practice Location Address
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Address Line | 411 SHANNOCK RD
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City | WAKEFIELD
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State | RI
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Zip | 02879-4750
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Country | US
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Telephone | 401-209-0902
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Fax |
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Provider Business Mailing Address
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Address Line | 411 SHANNOCK RD
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City | WAKEFIELD
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State | RI
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Zip | 02879-4750
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Country | US
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Telephone | 401-209-0902
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Fax |
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Authorized Official
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Title or Position | CORPORATE OFFICER
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Name | MR. JONATHAN J BURROWS
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Credential | MA, LCDP, SAP
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Telephone | 401-209-0902
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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 |
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License Number State |
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