Provider Demographics
NPI:1356805329
Name:COMPASSIONATE CARE COUNSELING LLC
Entity type:Organization
Organization Name:COMPASSIONATE CARE COUNSELING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:TUCKER
Authorized Official - Last Name:DERAGON
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW
Authorized Official - Phone:401-419-6175
Mailing Address - Street 1:69 BAIRD AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02904-3642
Mailing Address - Country:US
Mailing Address - Phone:401-660-0463
Mailing Address - Fax:
Practice Address - Street 1:1525 OLD LOUISQUISSET PIKE STE 203
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:RI
Practice Address - Zip Code:02865-4503
Practice Address - Country:US
Practice Address - Phone:401-660-0463
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-24
Last Update Date:2019-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty