Provider Demographics
NPI:1316552722
Name:RILEY, MATTHEW RAY (LCSWA)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:RAY
Last Name:RILEY
Suffix:
Gender:M
Credentials:LCSWA
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 8212
Mailing Address - Street 2:
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28814-8212
Mailing Address - Country:US
Mailing Address - Phone:828-284-8558
Mailing Address - Fax:
Practice Address - Street 1:36 SWEET CIDER LN
Practice Address - Street 2:
Practice Address - City:BURNSVILLE
Practice Address - State:NC
Practice Address - Zip Code:28714-9730
Practice Address - Country:US
Practice Address - Phone:828-284-8558
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-11
Last Update Date:2020-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0151611041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical