Provider Demographics
NPI:1275744922
Name:RILEY, WILLIAM STUART SR (LPC)
Entity Type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:STUART
Last Name:RILEY
Suffix:SR
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:195 OAKMONT DR
Mailing Address - Street 2:
Mailing Address - City:DAWSONVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30534-7731
Mailing Address - Country:US
Mailing Address - Phone:706-974-8755
Mailing Address - Fax:706-216-7909
Practice Address - Street 1:137 PROMINENCE CT
Practice Address - Street 2:SUITE 220
Practice Address - City:DAWSONVILLE
Practice Address - State:GA
Practice Address - Zip Code:30534-8953
Practice Address - Country:US
Practice Address - Phone:706-216-4735
Practice Address - Fax:706-216-7909
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-24
Last Update Date:2013-11-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GALPC0001338101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional