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BEVERLY FAIRHURST M.A., LCMHC, LCDP

Addiction Substance Use Disorder

East Providence, Rhode Island

Provider NPI: 1992780449

Provider Information:
 BEVERLY  FAIRHURST M.A., LCMHC, LCDP
Gender: F
Not Sole Proprietor

Practice Location:
610 WAMPANOAG TRL  EAST PROVIDENCE, RI 02915 US
Tel: 401-431-9870  Fax: 401-435-7486

Business Mailing Address:
7 ROCCO AVE  PAWTUCKET, RI 02860 US
Tel: 401-725-2278  Fax: --

Entity Type: Individual

Taxonomy:

PrimaryCodeCategory/DescriptionStateLicense Number
X101YA0400XBehavioral Health & Social Service Providers
Counselor
Addiction (Substance Use Disorder)
RI00027
X101YM0800XBehavioral Health & Social Service Providers
Counselor
RI80

Other Provider Identifiers:

IssuerNumberStateType
BF15322RI05
UNITED62-34366RI01
BLUE CROSS30016-6RI01
BLUE CHIP406396RI01
Code values:
01, Other | 02, Medicare Upin | 04, Medicare Id-Type Unspecified
05, Medicaid | 06, Medicare Oscar/Certification | 07, Medicare NSC | 08, Medicare Pin







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