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General NPI Number Information
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NPI Number | 1457878274
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Entity Type | Organization
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Legal Business Name | RIVERSTONE WELLNESS COLLABORATIVE
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Dates
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Enumeration Date | 08/23/2017
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 4070 BARRETT DR
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City | RALEIGH
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State | NC
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Zip | 27609-6604
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Country | US
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Telephone | 919-307-2777
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Fax |
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Provider Business Mailing Address
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Address Line | 4070 BARRETT DR
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City | RALEIGH
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State | NC
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Zip | 27609-6604
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Country | US
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Telephone | 919-307-2777
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | PHILLIP MICHAEL BASS
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Credential | LPC
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Telephone | 919-307-2777
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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 |
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License Number State |
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