Provider Demographics
NPI:1972090967
Name:RIVERSIDE COUNSELING, LLC
Entity Type:Organization
Organization Name:RIVERSIDE COUNSELING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOEL
Authorized Official - Middle Name:PATRICK
Authorized Official - Last Name:DAVISON
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:814-230-3042
Mailing Address - Street 1:438 PENNSYLVANIA AVE W
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:PA
Mailing Address - Zip Code:16365-2238
Mailing Address - Country:US
Mailing Address - Phone:814-230-3042
Mailing Address - Fax:
Practice Address - Street 1:438 PENNSYLVANIA AVE W
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:PA
Practice Address - Zip Code:16365-2238
Practice Address - Country:US
Practice Address - Phone:814-230-3042
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-16
Last Update Date:2022-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW018306251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health