Provider Demographics
NPI:1083168215
Name:RILES, ANITA J
Entity Type:Individual
Prefix:
First Name:ANITA
Middle Name:J
Last Name:RILES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3218 TURTON AVE
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32208-1317
Mailing Address - Country:US
Mailing Address - Phone:904-465-0876
Mailing Address - Fax:904-768-9094
Practice Address - Street 1:3218 TURTON AVE
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32208-1317
Practice Address - Country:US
Practice Address - Phone:904-465-0876
Practice Address - Fax:904-768-9094
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-04
Last Update Date:2016-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)