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General NPI Number Information
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NPI Number | 1861156648
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Entity Type | Individual
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Provider Name | MICKEY D RIIS
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Gender | Female
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Dates
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Enumeration Date | 10/27/2021
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Last Update Date | 03/20/2024
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Provider Practice Location Address
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Address Line | 925 CONFERENCE DR
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City | GREENVILLE
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State | NC
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Zip | 27858-5971
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Country | US
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Telephone | 252-689-6645
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Fax |
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Provider Business Mailing Address
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Address Line | 2616 SPRING CREEK DR
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City | GRIMESLAND
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State | NC
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Zip | 27837-9127
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Country | US
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Telephone | 251-643-4848
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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 | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number | 2021-089
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License Number State | AL
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