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General NPI Number Information
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NPI Number | 1316787484
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Entity Type | Individual
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Provider Name | ROXANA RIVAS-HERNANDEZ
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Gender | Female
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Dates
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Enumeration Date | 05/28/2024
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Last Update Date | 05/28/2024
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Provider Practice Location Address
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Address Line | 3205 S CHEROKEE LN STE 130
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City | WOODSTOCK
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State | GA
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Zip | 30188-5402
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Country | US
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Telephone | 770-300-7850
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Fax |
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Provider Business Mailing Address
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Address Line | 361 HERITAGE PARK TRCE NW
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City | KENNESAW
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State | GA
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Zip | 30144-4832
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Country | US
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Telephone | 404-429-2811
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Fax |
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | MSW011545
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License Number State | GA
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