Provider Demographics
NPI:1962014795
Name:RIVERS, TAMRA E
Entity Type:Individual
Prefix:
First Name:TAMRA
Middle Name:E
Last Name:RIVERS
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 1:201 LENNOX LOOP
Mailing Address - Street 2:
Mailing Address - City:RAEFORD
Mailing Address - State:NC
Mailing Address - Zip Code:28376-9224
Mailing Address - Country:US
Mailing Address - Phone:863-521-3900
Mailing Address - Fax:
Practice Address - Street 1:2105 E ELIZABETHTOWN RD
Practice Address - Street 2:
Practice Address - City:LUMBERTON
Practice Address - State:NC
Practice Address - Zip Code:28358-3107
Practice Address - Country:US
Practice Address - Phone:863-521-3900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-22
Last Update Date:2021-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC106S00000X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician