Kim Marie Gonzaga, LCDP

Primary specialty

Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X

License

CDP01032 Issued in RI

Practice address

4705 Old Post Rd
Charlestown, RI 02813-1841

Phone

(401) 364-7705

Fax

(401) 364-1982

NPI assigned

Mar 24, 2025

Last updated

May 16, 2025By the provider in NPPES

Sex

Unspecified or another gender identity

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Codac Inc

  dba Codac South County

  • Methadone Clinic
  • Saunderstown, RI
  • NPI 1679799217
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1742774400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1747353600000",
    "number": "1215738265",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "117 ELLENFIELD ST STE 101",
            "city": "PROVIDENCE",
            "state": "RI",
            "postal_code": "029054541"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4705 OLD POST RD",
            "city": "CHARLESTOWN",
            "state": "RI",
            "postal_code": "028131841",
            "telephone_number": "401-364-7705",
            "fax_number": "401-364-1982"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GONZAGA",
        "first_name": "KIM",
        "middle_name": "MARIE",
        "credential": "LCDP",
        "sole_proprietor": "NO",
        "sex": "X",
        "enumeration_date": "2025-03-24",
        "last_updated": "2025-05-16",
        "certification_date": "2025-05-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "RI",
            "license": "CDP01032",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kathleen Garlick, PC
• Craig Warren Gaspard, LICSW
• Gateway Healthcare, Inc
• Rebecca Gessow, LICSW
• Romeo Ghraieb, DMD
• Brendan C. Gouin, D.M.D.
• Bruce D Gouin, D.M.D.
• Teresa W Greer, MD
• Jessica Harrison
• Sarah Hauser, LCSW

• Addiction (Substance Use Disorder) Counselor in Charlestown, RI
• Providers in Charlestown, RI by specialty
• Addiction (Substance Use Disorder) Counselor in Rhode Island

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 16, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.