Provider Demographics
NPI:1073147690
Name:RILEY, LIBERTY DAWN (LMFT)
Entity Type:Individual
Prefix:MRS
First Name:LIBERTY
Middle Name:DAWN
Last Name:RILEY
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3005 DELLWOOD DR
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27408-3509
Mailing Address - Country:US
Mailing Address - Phone:336-906-3196
Mailing Address - Fax:
Practice Address - Street 1:6 DUNDAS CIR
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27407-1615
Practice Address - Country:US
Practice Address - Phone:336-641-7528
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-24
Last Update Date:2020-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1845106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist