Provider Demographics
NPI:1629471446
Name:RIVERSIDE COUNSELING CENTER LLC
Entity Type:Organization
Organization Name:RIVERSIDE COUNSELING CENTER LLC
Other - Org Name:PATRICIA A AREL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO/OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:A
Authorized Official - Last Name:AREL
Authorized Official - Suffix:
Authorized Official - Credentials:LCMHC
Authorized Official - Phone:401-270-7379
Mailing Address - Street 1:205 BULLOCKS POINT AVE
Mailing Address - Street 2:SUITE 205 B
Mailing Address - City:RIVERSIDE
Mailing Address - State:RI
Mailing Address - Zip Code:02915-5336
Mailing Address - Country:US
Mailing Address - Phone:401-270-7379
Mailing Address - Fax:401-270-1824
Practice Address - Street 1:205 BULLOCKS POINT AVE
Practice Address - Street 2:SUITE 205 B
Practice Address - City:RIVERSIDE
Practice Address - State:RI
Practice Address - Zip Code:02915-5336
Practice Address - Country:US
Practice Address - Phone:401-270-7379
Practice Address - Fax:401-270-1824
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-07
Last Update Date:2014-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RICDP00290101YA0400X
RIMHC00181101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
RIPA32211Medicaid