Provider Demographics
NPI:1578450110
Name:LATERRA, CHELSEY KAI (LCDP)
Entity type:Individual
Prefix:
First Name:CHELSEY
Middle Name:KAI
Last Name:LATERRA
Suffix:
Gender:F
Credentials:LCDP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1220 KINGSTOWN RD
Mailing Address - Street 2:
Mailing Address - City:WAKEFIELD
Mailing Address - State:RI
Mailing Address - Zip Code:02879-7909
Mailing Address - Country:US
Mailing Address - Phone:401-789-9390
Mailing Address - Fax:401-789-3454
Practice Address - Street 1:1220 KINGSTOWN RD
Practice Address - Street 2:
Practice Address - City:WAKEFIELD
Practice Address - State:RI
Practice Address - Zip Code:02879-7909
Practice Address - Country:US
Practice Address - Phone:401-789-9390
Practice Address - Fax:401-789-3454
Is Sole Proprietor?:No
Enumeration Date:2025-06-18
Last Update Date:2025-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RICDP01048101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)