Provider Demographics
NPI:1265914477
Name:OCEAN STATE COUNSELING AND WELLNESS CENTER
Entity type:Organization
Organization Name:OCEAN STATE COUNSELING AND WELLNESS CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:A
Authorized Official - Last Name:MCGUIRE
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:401-241-3344
Mailing Address - Street 1:PO BOX 582
Mailing Address - Street 2:
Mailing Address - City:N SCITUATE
Mailing Address - State:RI
Mailing Address - Zip Code:02857-0582
Mailing Address - Country:US
Mailing Address - Phone:401-241-3344
Mailing Address - Fax:888-456-2467
Practice Address - Street 1:1395 ATWOOD AVE
Practice Address - Street 2:SUITE 206
Practice Address - City:JOHNSTON
Practice Address - State:RI
Practice Address - Zip Code:02919-4931
Practice Address - Country:US
Practice Address - Phone:401-241-3344
Practice Address - Fax:888-458-2467
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-04
Last Update Date:2019-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounselingGroup - Multi-Specialty