Provider Demographics
NPI:1871684688
Name:SHUTTLESWORTH, DIANNE GEE (LCDCS)
Entity Type:Individual
Prefix:MS
First Name:DIANNE
Middle Name:GEE
Last Name:SHUTTLESWORTH
Suffix:
Gender:F
Credentials:LCDCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:166 PAWTUCKET AVE
Mailing Address - Street 2:
Mailing Address - City:PAWTUCKET
Mailing Address - State:RI
Mailing Address - Zip Code:02860-3811
Mailing Address - Country:US
Mailing Address - Phone:401-683-3765
Mailing Address - Fax:401-722-4867
Practice Address - Street 1:166 PAWTUCKET AVE
Practice Address - Street 2:
Practice Address - City:PAWTUCKET
Practice Address - State:RI
Practice Address - Zip Code:02860-3811
Practice Address - Country:US
Practice Address - Phone:401-722-4644
Practice Address - Fax:401-722-4867
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RILCDCS00020101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)