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NPI Code Detail

MEDICARE: MRS. KENYA RIVERS-FULLER LLMSW

MEDICARE: MRS. KENYA RIVERS-FULLER LLMSW
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1104100000XSocial Worker6802087990MI

General Provider Information

NPI Number : 1598180846
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. KENYA RIVERS-FULLER LLMSW
Provider Business Mailing Address
First Line : 10839 WESTPOINT ST
Second Line :
City : TAYLOR
State : MI
Zip : 48180-3482
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 26184 OUTER DR
Second Line :
City : LINCOLN PARK
State : MI
Zip : 48146-2084
Country : US
Telephone Number : 313-389-7500
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/24/2014
Last Update Date : 05/18/2026

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