MEDICARE: RIA PATEL

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
1	101YM0800X	Mental Health Counselor	A16983	NC

General Provider Information

NPI Number	:	1851053938
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RIA PATEL

Provider Business Mailing Address
First Line	:	100 WATERSTONE LN
Second Line	:
City	:	JACKSONVILLE
State	:	NC
Zip	:	28546-8804
Country	:	US
Telephone Number	:	570-637-3854
Fax Number	:

Provider Business Practice Location Address
First Line	:	715 GUM BRANCH RD STE 1
Second Line	:
City	:	JACKSONVILLE
State	:	NC
Zip	:	28540-6427
Country	:	US
Telephone Number	:	910-333-1031
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/06/2021
Last Update Date	:	10/06/2021

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Directions to “ RIA PATEL ” Practice Location

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