Provider Demographics
NPI:1821486168
Name:RIVERA, MARIA DOLORES (LPC)
Entity Type:Individual
Prefix:MRS
First Name:MARIA
Middle Name:DOLORES
Last Name:RIVERA
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:MRS
Other - First Name:MARIA
Other - Middle Name:DOLORES
Other - Last Name:VALENCIA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC
Mailing Address - Street 1:410 N 4TH ST
Mailing Address - Street 2:
Mailing Address - City:LONGVIEW
Mailing Address - State:TX
Mailing Address - Zip Code:75601
Mailing Address - Country:US
Mailing Address - Phone:903-234-8808
Mailing Address - Fax:903-234-1108
Practice Address - Street 1:410 N 4TH ST
Practice Address - Street 2:
Practice Address - City:LONGVIEW
Practice Address - State:TX
Practice Address - Zip Code:75601
Practice Address - Country:US
Practice Address - Phone:903-234-8808
Practice Address - Fax:903-234-1108
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-08
Last Update Date:2019-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX70425101YP2500X, 106H00000X, 101YP2500X
101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist