Healthcare Provider Details

I. General information

NPI: 1639001399
Provider Name (Legal Business Name): DEVORA R RIVERA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/29/2026
Last Update Date: 05/29/2026
Certification Date: 05/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 N QUINCY ST STE 601
ARLINGTON VA
22203-1729
US

IV. Provider business mailing address

1410 N SCOTT ST APT 1137
ARLINGTON VA
22209-2984
US

V. Phone/Fax

Practice location:
  • Phone: 571-457-2722
  • Fax:
Mailing address:
  • Phone: 571-457-2722
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0704018343
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: