Provider Demographics
NPI:1225163884
Name:RILEY, SARA E (MSCP, LPC, NCC)
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:E
Last Name:RILEY
Suffix:
Gender:F
Credentials:MSCP, LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2552
Mailing Address - Street 2:
Mailing Address - City:VALDOSTA
Mailing Address - State:GA
Mailing Address - Zip Code:31604-2552
Mailing Address - Country:US
Mailing Address - Phone:229-563-6169
Mailing Address - Fax:
Practice Address - Street 1:2200 N PATTERSON ST
Practice Address - Street 2:
Practice Address - City:VALDOSTA
Practice Address - State:GA
Practice Address - Zip Code:31602-2597
Practice Address - Country:US
Practice Address - Phone:229-244-1707
Practice Address - Fax:299-244-1779
Is Sole Proprietor?:No
Enumeration Date:2007-02-23
Last Update Date:2009-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GANCC223805101Y00000X
GALPC 004549101YM0800X
GALPC0004549101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health