Provider Demographics
NPI:1568977486
Name:RIVERA, ALFREDO JR (LCMHC, NCC)
Entity Type:Individual
Prefix:
First Name:ALFREDO
Middle Name:
Last Name:RIVERA
Suffix:JR
Gender:M
Credentials:LCMHC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23 SUNNYBROOK RD
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27610-1855
Mailing Address - Country:US
Mailing Address - Phone:919-235-6510
Mailing Address - Fax:919-231-0314
Practice Address - Street 1:23 SUNNYBROOK RD
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27610-1855
Practice Address - Country:US
Practice Address - Phone:919-235-6510
Practice Address - Fax:919-231-0314
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-14
Last Update Date:2021-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY7974101YP2500X
NC13574101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional