Provider Demographics
NPI:1114166915
Name:RIVERSIDE COUNSELING AND CONSULTING, P.C.
Entity Type:Organization
Organization Name:RIVERSIDE COUNSELING AND CONSULTING, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:TINSLEY
Authorized Official - Last Name:GIBSON
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:256-340-0300
Mailing Address - Street 1:401 GRANT ST SE
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:AL
Mailing Address - Zip Code:35601-3003
Mailing Address - Country:US
Mailing Address - Phone:256-340-0300
Mailing Address - Fax:256-340-0353
Practice Address - Street 1:401 GRANT ST SE
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:AL
Practice Address - Zip Code:35601-3003
Practice Address - Country:US
Practice Address - Phone:256-340-0300
Practice Address - Fax:256-340-0353
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-18
Last Update Date:2009-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1699101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty