Provider Demographics
NPI:1467048108
Name:TENBRINK, STACEY (LCDP)
Entity Type:Individual
Prefix:
First Name:STACEY
Middle Name:
Last Name:TENBRINK
Suffix:
Gender:F
Credentials:LCDP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1023 POST RD
Mailing Address - Street 2:
Mailing Address - City:WARWICK
Mailing Address - State:RI
Mailing Address - Zip Code:02888-3363
Mailing Address - Country:US
Mailing Address - Phone:401-773-7116
Mailing Address - Fax:401-772-7106
Practice Address - Street 1:1023 POST RD
Practice Address - Street 2:
Practice Address - City:WARWICK
Practice Address - State:RI
Practice Address - Zip Code:02888-3363
Practice Address - Country:US
Practice Address - Phone:401-773-7116
Practice Address - Fax:401-772-7106
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-16
Last Update Date:2020-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RICDP00850101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)