MEDICARE: STELLA M HEBBLE LCDP LCDCS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YA0400X	Addiction (Substance Use Disorder) Counselor	LCDCS00182	RI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	6242626	OTHER	RI	UBH

General Provider Information

NPI Number	:	1083718787
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STELLA M HEBBLE LCDP LCDCS

Provider Business Mailing Address
First Line	:	380 MIDDLE HIGHWAY
Second Line	:
City	:	BARRINGTON
State	:	RI
Zip	:	02806
Country	:	US
Telephone Number	:	401-247-4872
Fax Number	:

Provider Business Practice Location Address
First Line	:	300 CENTERVILLE RD
Second Line	:	SUITE 104
City	:	WARWICK
State	:	RI
Zip	:	02886
Country	:	US
Telephone Number	:	401-732-5656
Fax Number	:	401-738-8634

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/12/2006
Last Update Date	:	07/08/2007

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