Provider Demographics
NPI:1669014387
Name:RILEY-EATON, RASCHELLE ARLENE
Entity Type:Individual
Prefix:
First Name:RASCHELLE
Middle Name:ARLENE
Last Name:RILEY-EATON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2149 W 1ST ST UNIT 241
Mailing Address - Street 2:
Mailing Address - City:GULF SHORES
Mailing Address - State:AL
Mailing Address - Zip Code:36547-8412
Mailing Address - Country:US
Mailing Address - Phone:251-597-1759
Mailing Address - Fax:
Practice Address - Street 1:2033 W 1ST ST STE 3
Practice Address - Street 2:
Practice Address - City:GULF SHORES
Practice Address - State:AL
Practice Address - Zip Code:36542-4447
Practice Address - Country:US
Practice Address - Phone:251-597-0417
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-14
Last Update Date:2019-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL4158101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional