Provider Demographics
NPI:1902575186
Name:LESPERANCE, MICHELLE L (BS CCSP LCDP)
Entity type:Individual
Prefix:MS
First Name:MICHELLE
Middle Name:L
Last Name:LESPERANCE
Suffix:
Gender:F
Credentials:BS CCSP LCDP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:49 HEBERT ST
Mailing Address - Street 2:
Mailing Address - City:WEST WARWICK
Mailing Address - State:RI
Mailing Address - Zip Code:02893-5703
Mailing Address - Country:US
Mailing Address - Phone:401-952-2006
Mailing Address - Fax:
Practice Address - Street 1:188 ACADEMY AVE
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02908-4452
Practice Address - Country:US
Practice Address - Phone:401-528-0003
Practice Address - Fax:401-276-4676
Is Sole Proprietor?:No
Enumeration Date:2021-09-10
Last Update Date:2021-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RICDP00884101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)