Provider Demographics
NPI:1275139057
Name:MICHAUD, KATELYN RITA (CADC, LCDP)
Entity Type:Individual
Prefix:
First Name:KATELYN
Middle Name:RITA
Last Name:MICHAUD
Suffix:
Gender:F
Credentials:CADC, LCDP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1700
Mailing Address - Street 2:
Mailing Address - City:WOONSOCKET
Mailing Address - State:RI
Mailing Address - Zip Code:02895-0856
Mailing Address - Country:US
Mailing Address - Phone:401-235-7000
Mailing Address - Fax:401-767-4516
Practice Address - Street 1:100 RANDALL ST
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02904-2723
Practice Address - Country:US
Practice Address - Phone:401-235-7000
Practice Address - Fax:401-767-4516
Is Sole Proprietor?:No
Enumeration Date:2020-12-08
Last Update Date:2022-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RICDP00853101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)