Provider Demographics
NPI:1881119675
Name:DUBOIS, SHIANA NADINE
Entity type:Individual
Prefix:
First Name:SHIANA
Middle Name:NADINE
Last Name:DUBOIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3047 E MAIN RD STE 4
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:RI
Mailing Address - Zip Code:02871-4263
Mailing Address - Country:US
Mailing Address - Phone:401-684-1787
Mailing Address - Fax:
Practice Address - Street 1:3047 E MAIN RD STE 4
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:RI
Practice Address - Zip Code:02871-4263
Practice Address - Country:US
Practice Address - Phone:401-684-1787
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-14
Last Update Date:2023-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMHC01486101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health