Provider Demographics
NPI:1013189257
Name:RILEY, REGINALD B (PHD)
Entity Type:Individual
Prefix:DR
First Name:REGINALD
Middle Name:B
Last Name:RILEY
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8000 MILLER CT E
Mailing Address - Street 2:
Mailing Address - City:NORCROSS
Mailing Address - State:GA
Mailing Address - Zip Code:30071-1456
Mailing Address - Country:US
Mailing Address - Phone:770-734-8091
Mailing Address - Fax:770-734-8094
Practice Address - Street 1:8000 MILLER CT E
Practice Address - Street 2:
Practice Address - City:NORCROSS
Practice Address - State:GA
Practice Address - Zip Code:30071-1456
Practice Address - Country:US
Practice Address - Phone:770-734-8091
Practice Address - Fax:770-734-8094
Is Sole Proprietor?:No
Enumeration Date:2008-03-27
Last Update Date:2008-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAMSW003688101Y00000X, 101YA0400X, 101YM0800X, 104100000X, 1041C0700X
GAMSW00368101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical