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General NPI Number Information
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NPI Number | 1821810433
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Entity Type | Individual
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Provider Name | JENNICELE RIVAS APC
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Gender | Female
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Dates
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Enumeration Date | 10/26/2024
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Last Update Date | 12/18/2025
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Provider Practice Location Address
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Address Line | 1400 BUFORD HWY STE C1
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City | BUFORD
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State | GA
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Zip | 30518-8722
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Country | US
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Telephone | 470-238-9881
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Fax |
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Provider Business Mailing Address
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Address Line | 110 MANOR WAY
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City | BRASELTON
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State | GA
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Zip | 30517-3579
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Country | US
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Telephone | 770-990-0000
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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 | LPC016093
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License Number State | GA
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