Provider Demographics
NPI:1194499319
Name:JRD COUNSELING
Entity type:Organization
Organization Name:JRD COUNSELING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:
Authorized Official - Last Name:REIS-DRISCOLL
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW
Authorized Official - Phone:401-489-3635
Mailing Address - Street 1:10 ELMGROVE AVE
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02906-4124
Mailing Address - Country:US
Mailing Address - Phone:401-271-3689
Mailing Address - Fax:
Practice Address - Street 1:10 ELMGROVE AVE
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02906-4124
Practice Address - Country:US
Practice Address - Phone:401-271-3698
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-02
Last Update Date:2023-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty