Basic Information
| Provider Information | |||||||||
| NPI: | 1902185762 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | OULETTE | ||||||||
| FirstName: | BRIENNA | ||||||||
| MiddleName: | |||||||||
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| Credential: | LCSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2024 BROAD ST | ||||||||
| Address2: | |||||||||
| City: | CRANSTON | ||||||||
| State: | RI | ||||||||
| PostalCode: | 029053424 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4017570206 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 428 BILTMORE AVE | ||||||||
| Address2: | |||||||||
| City: | ASHEVILLE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 288014502 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8282134502 | ||||||||
| FaxNumber: | 8282134540 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/11/2011 | ||||||||
| LastUpdateDate: | 03/17/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101Y00000X | C512 | RI | N | Behavioral Health & Social Service Providers | Counselor | 104100000X | CSW01442 | RI | N | Behavioral Health & Social Service Providers | Social Worker | 1041C0700X | ISW02454 | RI | N | Behavioral Health & Social Service Providers | Social Worker | Clinical | 1041C0700X | C011222 | NC | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.