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General NPI Number Information
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NPI Number | 1477987394
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Entity Type | Organization
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Legal Business Name | RIVERSIDE PSYCHOTHERAPY, PLLC
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Dates
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Enumeration Date | 08/27/2013
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Last Update Date | 12/06/2021
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Provider Practice Location Address
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Address Line | 3914 SAINT ELMO AVE STE C
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City | CHATTANOOGA
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State | TN
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Zip | 37409-1269
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Country | US
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Telephone | 423-802-6943
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Fax | 888-508-6829
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Provider Business Mailing Address
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Address Line | 3914 SAINT ELMO AVE STE C
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City | CHATTANOOGA
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State | TN
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Zip | 37409-1269
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Country | US
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Telephone | 423-802-6943
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Fax | 888-508-2869
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Authorized Official
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Title or Position | OFFICE MANAGER/THERAPIST
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Name | MS. LAURA SUSAN SIKES
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Credential | MA, LPC-MHSP
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Telephone | 423-802-6943
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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 | 2864
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License Number State | TN
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