Provider Demographics
NPI:1033745542
Name:RIVERS, DIA MICHELLE (LPC)
Entity Type:Individual
Prefix:
First Name:DIA
Middle Name:MICHELLE
Last Name:RIVERS
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:DIA
Other - Middle Name:MICHELLE
Other - Last Name:RIVERS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LPC
Mailing Address - Street 1:15134 GREENWING ST
Mailing Address - Street 2:
Mailing Address - City:CALDWELL
Mailing Address - State:ID
Mailing Address - Zip Code:83607-5506
Mailing Address - Country:US
Mailing Address - Phone:208-740-3372
Mailing Address - Fax:
Practice Address - Street 1:15134 GREENWING ST
Practice Address - Street 2:
Practice Address - City:CALDWELL
Practice Address - State:ID
Practice Address - Zip Code:83607-5506
Practice Address - Country:US
Practice Address - Phone:208-740-3372
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-16
Last Update Date:2023-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor