Provider Demographics
NPI:1003267444
Name:RIVERS, SHELIA (DSW, LCSW, MPH)
Entity Type:Individual
Prefix:DR
First Name:SHELIA
Middle Name:
Last Name:RIVERS
Suffix:
Gender:F
Credentials:DSW, LCSW, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 255
Mailing Address - Street 2:
Mailing Address - City:GULFPORT
Mailing Address - State:MS
Mailing Address - Zip Code:39502-0255
Mailing Address - Country:US
Mailing Address - Phone:707-728-5131
Mailing Address - Fax:
Practice Address - Street 1:417 SECURITY SQ
Practice Address - Street 2:
Practice Address - City:GULFPORT
Practice Address - State:MS
Practice Address - Zip Code:39507-1922
Practice Address - Country:US
Practice Address - Phone:707-728-5131
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-27
Last Update Date:2023-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL3831C1041C0700X
MSC80891041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical