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General NPI Number Information
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NPI Number | 1629476395
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Entity Type | Individual
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Provider Name | CARMITA RIVERS LPC
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Gender | Female
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Dates
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Enumeration Date | 12/12/2014
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Last Update Date | 03/17/2018
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Provider Practice Location Address
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Address Line | 2795 MAIN STREET WEST SUITE 19B
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City | SNELLVILLE
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State | GA
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Zip | 30078-3072
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Country | US
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Telephone | 404-671-5895
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Fax | 770-674-7854
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Provider Business Mailing Address
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Address Line | PO BOX 957676
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City | DULUTH
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State | GA
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Zip | 30095-9528
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Country | US
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Telephone |
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number | 008191
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License Number State | GA
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