Basic Information
| Provider Information | |||||||||
| NPI: | 1700425956 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LOPES | ||||||||
| FirstName: | KIANA | ||||||||
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| Credential: | LCDP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 20 ALICE ST | ||||||||
| Address2: | |||||||||
| City: | PAWTUCKET | ||||||||
| State: | RI | ||||||||
| PostalCode: | 028602704 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4012861795 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2 OLD COUNTY RD | ||||||||
| Address2: | |||||||||
| City: | BARRINGTON | ||||||||
| State: | RI | ||||||||
| PostalCode: | 028061600 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4012461195 | ||||||||
| FaxNumber: | 4012463078 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/04/2020 | ||||||||
| LastUpdateDate: | 01/04/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 01/04/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | CDP00816 | RI | Y | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) |
No ID Information.