MEDICARE: PEACE IN MIND COUNSELING, LLC

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	251S00000X	Community/Behavioral Health Agency	MHC00671	RI

General Provider Information

NPI Number	:	1588042402
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PEACE IN MIND COUNSELING, LLC

Provider Business Mailing Address
First Line	:	P.O. BOX 37
Second Line	:
City	:	SAUNDERSTOWN
State	:	RI
Zip	:	02874
Country	:	US
Telephone Number	:	401-400-2949
Fax Number	:

Provider Business Practice Location Address
First Line	:	320 PHILLIPS ST
Second Line	:	SUITE 103
City	:	NORTH KINGSTOWN
State	:	RI
Zip	:	02852-5166
Country	:	US
Telephone Number	:	401-400-2949
Fax Number	:	401-400-2949

Authorized Official
Title or Position	:	OWNER
Name	:	DONNA MARIE MASSEY
Credential	:	LMHC
Telephone Number	:	401-400-2949

Provider Enumeration Date	:	05/12/2015
Last Update Date	:	02/19/2019

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