Provider Demographics
NPI:1609970748
Name:RILEY, RICHARD WENDELL (MASTER SOCIAL WORKER)
Entity Type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:WENDELL
Last Name:RILEY
Suffix:
Gender:M
Credentials:MASTER SOCIAL WORKER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4113 QUINN DR
Mailing Address - Street 2:
Mailing Address - City:EVANS
Mailing Address - State:GA
Mailing Address - Zip Code:30809-4815
Mailing Address - Country:US
Mailing Address - Phone:706-733-0188
Mailing Address - Fax:706-481-6791
Practice Address - Street 1:VA MEDICAL CENTER 1 FREEDOM WAY
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30904
Practice Address - Country:US
Practice Address - Phone:706-733-0188
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNCSW6185104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker