Healthcare Provider Details

I. General information

NPI: 1174389555
Provider Name (Legal Business Name): YILANEE RIVERA IRIZARRY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/23/2024
Last Update Date: 02/23/2024
Certification Date: 02/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

902 S REILLY RD
FAYETTEVILLE NC
28314-1825
US

IV. Provider business mailing address

402 HARRIS AVE
RAEFORD NC
28376-3112
US

V. Phone/Fax

Practice location:
  • Phone: 910-491-6356
  • Fax: 910-491-8128
Mailing address:
  • Phone: 910-875-5590
  • Fax: 910-875-5008

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberA19773
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: