Provider Demographics
NPI:1609630326
Name:COSMIC HEALING LLC
Entity Type:Organization
Organization Name:COSMIC HEALING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KRISTINA
Authorized Official - Middle Name:
Authorized Official - Last Name:CARLSON
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC, LCDP
Authorized Official - Phone:401-575-8559
Mailing Address - Street 1:1239 HILL FARM RD
Mailing Address - Street 2:
Mailing Address - City:COVENTRY
Mailing Address - State:RI
Mailing Address - Zip Code:02816-6936
Mailing Address - Country:US
Mailing Address - Phone:401-575-8559
Mailing Address - Fax:
Practice Address - Street 1:2893 POST RD
Practice Address - Street 2:
Practice Address - City:WARWICK
Practice Address - State:RI
Practice Address - Zip Code:02886-3117
Practice Address - Country:US
Practice Address - Phone:401-575-8559
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-13
Last Update Date:2024-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health