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General NPI Number Information
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NPI Number | 1740489137
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Entity Type | Individual
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Provider Name | CARMEN J RILEY M.ED., LPC
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Gender | Female
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Dates
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Enumeration Date | 07/16/2007
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Last Update Date | 03/18/2016
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Provider Practice Location Address
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Address Line | 15915 CANADA GOOSE LOOP
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City | WOODBRIDGE
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State | VA
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Zip | 22191-5562
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Country | US
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Telephone | 571-989-2927
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Fax |
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Provider Business Mailing Address
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Address Line | 15915 CANADA GOOSE LOOP
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City | WOODBRIDGE
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State | VA
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Zip | 22191-5562
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Country | US
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Telephone | 571-989-2927
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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 | PRC14584
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License Number State | DC
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 0701006505
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License Number State | VA
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