Provider Demographics
NPI:1730343781
Name:GOULD, DAVID E (LCDP,RCS)
Entity type:Individual
Prefix:MR
First Name:DAVID
Middle Name:E
Last Name:GOULD
Suffix:
Gender:M
Credentials:LCDP,RCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2076 WALLUM LAKE RD.
Mailing Address - Street 2:PO BOX 398
Mailing Address - City:BURRILLVILLE
Mailing Address - State:RI
Mailing Address - Zip Code:02859-1813
Mailing Address - Country:US
Mailing Address - Phone:401-568-1770
Mailing Address - Fax:401-568-3358
Practice Address - Street 1:2076 WALLUM LAKE RD.
Practice Address - Street 2:
Practice Address - City:BURRILLVILLE
Practice Address - State:RI
Practice Address - Zip Code:02859-1813
Practice Address - Country:US
Practice Address - Phone:401-568-1770
Practice Address - Fax:401-568-3358
Is Sole Proprietor?:No
Enumeration Date:2008-07-17
Last Update Date:2008-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RILCDP 00416101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)