MEDICARE: COREY LEIGHTON RILEY LPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	9263	SC

General Provider Information

NPI Number	:	1770242695
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	COREY LEIGHTON RILEY LPC

Provider Business Mailing Address
First Line	:	104 PICKENS ST
Second Line	:
City	:	CLOVER
State	:	SC
Zip	:	29710-1121
Country	:	US
Telephone Number	:	803-709-0122
Fax Number	:

Provider Business Practice Location Address
First Line	:	246 ROCKMONT DR
Second Line	:
City	:	FORT MILL
State	:	SC
Zip	:	29708-6477
Country	:	US
Telephone Number	:	803-820-2684
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/08/2021
Last Update Date	:	10/30/2023

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Directions to “ COREY LEIGHTON RILEY LPC” Practice Location

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