Provider Demographics
NPI:1497352645
Name:RIVERA SINK, VICTOR M (MS, LPC)
Entity Type:Individual
Prefix:
First Name:VICTOR
Middle Name:M
Last Name:RIVERA SINK
Suffix:
Gender:M
Credentials:MS, LPC
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 519
Mailing Address - Street 2:
Mailing Address - City:FERRUM
Mailing Address - State:VA
Mailing Address - Zip Code:24088-0519
Mailing Address - Country:US
Mailing Address - Phone:540-365-4469
Mailing Address - Fax:540-365-4272
Practice Address - Street 1:180 FERRUM MOUNTAIN RD
Practice Address - Street 2:
Practice Address - City:FERRUM
Practice Address - State:VA
Practice Address - Zip Code:24088-2939
Practice Address - Country:US
Practice Address - Phone:540-365-4469
Practice Address - Fax:540-365-4272
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-01
Last Update Date:2021-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701009947101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty