Provider Demographics
NPI:1528575123
Name:ILLUMINATE LIFE COUNSELING, LLC
Entity Type:Organization
Organization Name:ILLUMINATE LIFE COUNSELING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:KATHERINE
Authorized Official - Middle Name:
Authorized Official - Last Name:KINSELLA
Authorized Official - Suffix:
Authorized Official - Credentials:EDD, LMFT, LMHC
Authorized Official - Phone:843-696-6221
Mailing Address - Street 1:126 PAWTUXET TER
Mailing Address - Street 2:
Mailing Address - City:WEST WARWICK
Mailing Address - State:RI
Mailing Address - Zip Code:02893-5212
Mailing Address - Country:US
Mailing Address - Phone:843-696-6221
Mailing Address - Fax:
Practice Address - Street 1:2220 PLAINFIELD PIKE
Practice Address - Street 2:
Practice Address - City:CRANSTON
Practice Address - State:RI
Practice Address - Zip Code:02921-2031
Practice Address - Country:US
Practice Address - Phone:401-889-3788
Practice Address - Fax:401-223-6506
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-04
Last Update Date:2018-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMHC00885101YP2500X
RIMFT00179106H00000X
SC4649106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty