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General NPI Number Information
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NPI Number | 1275744922
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Entity Type | Individual
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Provider Name | WILLIAM STUART RILEY SR. LPC
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Gender | Male
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Dates
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Enumeration Date | 05/24/2007
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Last Update Date | 11/13/2013
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Provider Practice Location Address
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Address Line | 137 PROMINENCE CT SUITE 220
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City | DAWSONVILLE
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State | GA
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Zip | 30534-8953
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Country | US
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Telephone | 706-216-4735
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Fax | 706-216-7909
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Provider Business Mailing Address
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Address Line | 195 OAKMONT DR
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City | DAWSONVILLE
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State | GA
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Zip | 30534-7731
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Country | US
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Telephone | 706-974-8755
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Fax | 706-216-7909
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | LPC0001338
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License Number State | GA
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