Provider Demographics
NPI:1902054356
Name:COURNOYER, GEORGE C
Entity Type:Individual
Prefix:MR
First Name:GEORGE
Middle Name:C
Last Name:COURNOYER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:203 CONCORD ST
Mailing Address - Street 2:SUITE 463
Mailing Address - City:PAWTUCKET
Mailing Address - State:RI
Mailing Address - Zip Code:02860-3477
Mailing Address - Country:US
Mailing Address - Phone:401-727-1287
Mailing Address - Fax:401-727-1289
Practice Address - Street 1:203 CONCORD ST
Practice Address - Street 2:SUITE 463
Practice Address - City:PAWTUCKET
Practice Address - State:RI
Practice Address - Zip Code:02860-3477
Practice Address - Country:US
Practice Address - Phone:401-727-1287
Practice Address - Fax:401-727-1289
Is Sole Proprietor?:No
Enumeration Date:2008-08-28
Last Update Date:2008-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)