Provider Demographics
NPI:1205072295
Name:COWAN, DARLENE ALYCE (QMHP, LMHC)
Entity type:Individual
Prefix:
First Name:DARLENE
Middle Name:ALYCE
Last Name:COWAN
Suffix:
Gender:F
Credentials:QMHP, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 CLINTON ST
Mailing Address - Street 2:
Mailing Address - City:WOONSOCKET
Mailing Address - State:RI
Mailing Address - Zip Code:02895-3245
Mailing Address - Country:US
Mailing Address - Phone:401-235-7469
Mailing Address - Fax:401-767-4516
Practice Address - Street 1:800 CLINTON ST
Practice Address - Street 2:
Practice Address - City:WOONSOCKET
Practice Address - State:RI
Practice Address - Zip Code:02895-3245
Practice Address - Country:US
Practice Address - Phone:401-235-7469
Practice Address - Fax:401-767-4516
Is Sole Proprietor?:No
Enumeration Date:2008-12-23
Last Update Date:2016-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMHC00505101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI1205072295OtherUBH
RI1104847946OtherTHE PROVIDENCE CENTER NPI