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General NPI Number Information
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NPI Number | 1114166915
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Entity Type | Organization
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Legal Business Name | RIVERSIDE COUNSELING AND CONSULTING, P.C.
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Dates
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Enumeration Date | 02/18/2009
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Last Update Date | 02/18/2009
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Provider Practice Location Address
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Address Line | 401 GRANT ST SE
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City | DECATUR
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State | AL
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Zip | 35601-3003
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Country | US
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Telephone | 256-340-0300
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Fax | 256-340-0353
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Provider Business Mailing Address
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Address Line | 401 GRANT ST SE
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City | DECATUR
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State | AL
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Zip | 35601-3003
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Country | US
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Telephone | 256-340-0300
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Fax | 256-340-0353
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Authorized Official
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Title or Position | PRESIDENT
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Name | MS. DEBRA TINSLEY GIBSON
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Credential | LPC
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Telephone | 256-340-0300
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 1699
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License Number State | AL
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