Provider Demographics
NPI:1649775917
Name:RILEY, NATHIFA GRACE MKATE (LMSW)
Entity Type:Individual
Prefix:
First Name:NATHIFA
Middle Name:GRACE MKATE
Last Name:RILEY
Suffix:
Gender:F
Credentials:LMSW
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 401251
Mailing Address - Street 2:
Mailing Address - City:REDFORD
Mailing Address - State:MI
Mailing Address - Zip Code:48240-9251
Mailing Address - Country:US
Mailing Address - Phone:313-598-8381
Mailing Address - Fax:313-543-3237
Practice Address - Street 1:26150 5 MILE RD
Practice Address - Street 2:STE 33
Practice Address - City:REDFORD
Practice Address - State:MI
Practice Address - Zip Code:48239-3240
Practice Address - Country:US
Practice Address - Phone:313-598-8381
Practice Address - Fax:313-543-3237
Is Sole Proprietor?:No
Enumeration Date:2018-03-28
Last Update Date:2019-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010919101041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical