Provider Demographics
NPI:1962172247
Name:OUELLETTE, ALLISON G (LMHC, LCDP)
Entity type:Individual
Prefix:
First Name:ALLISON
Middle Name:G
Last Name:OUELLETTE
Suffix:
Gender:
Credentials:LMHC, LCDP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:42 VICTOR ST
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02908-3200
Mailing Address - Country:US
Mailing Address - Phone:401-282-0616
Mailing Address - Fax:
Practice Address - Street 1:42 VICTOR ST
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02908-3200
Practice Address - Country:US
Practice Address - Phone:401-282-0616
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-17
Last Update Date:2025-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YA0400X
RIMHC0106101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty