Healthcare Provider Details

I. General information

NPI: 1205668662
Provider Name (Legal Business Name): DYLAN JACOB RILEY RBT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/15/2024
Last Update Date: 07/02/2026
Certification Date: 07/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

215 CHURCH ST NW
LENOIR NC
28645-5116
US

IV. Provider business mailing address

215 CHURCH ST NW STE 103
LENOIR NC
28645-5116
US

V. Phone/Fax

Practice location:
  • Phone: 828-572-3414
  • Fax:
Mailing address:
  • Phone: 704-913-7826
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberA23129
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: