| NPI | 1023704970 |
|---|---|
| Former Name | JUSTIN BEAUCAGE |
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: RI CDP00906) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: RI MHC01829) |
| Enumeration Date | 2023-04-13 |
| Last Update Date | 2026-01-09 |