Roosevelt Dale
Individual provider Active NPI Addiction (Substance Use Disorder) Counselor · Johnston, RI
NPI 1962375477 · NPPES record last updated Dec 25, 2025
Key facts
- NPI
- 1962375477
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Addiction (Substance Use Disorder) Counselor 101YA0400X
- License
- CDP01081 (RI)
- Practice address
- 806 Greenville Ave
Johnston, RI 02919-1305 - Phone
- (401) 516-1314
- NPI assigned
- Sep 29, 2025
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| CDP01081 | RI | MD | Addiction (Substance Use Disorder) Counselor |
| 201835 | RI | MD | Community Health Worker |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Peerpoint Recovery Residences | Addiction (Substance Use Disorder) | Current |
Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | CDP01081 | RI | Yes |
| Community Health Worker | 172V00000X | 201835 | RI |
Addresses
Primary practice location
806 Greenville Ave
Johnston, RI 02919-1305
Mailing address
806 Greenville Ave
Johnston, RI 02919-1305
Phone (401) 516-1314
Other providers in Johnston, RI
- Vincent D'Alessandro
- Amanda D'Ercole
- Cheryl K. D'Itri
- Ndeye Yacine Dabo
- Onkar Dadiala
- Gabrielle Katharine Dancik
- Dawn Danella
- Sumit K Das
- Nikia Dasilva-Lopes
- Maria Christina Dasilva
All providers in Johnston, RI · Addiction (Substance Use Disorder) Counselor in Rhode Island
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 25, 2025. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.