Provider Demographics
NPI:1972101632
Name:DUDLEY RILEY, SHERITA VONDALE (MS, LPC)
Entity Type:Individual
Prefix:MRS
First Name:SHERITA
Middle Name:VONDALE
Last Name:DUDLEY RILEY
Suffix:
Gender:F
Credentials:MS, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 HOLLY HOCK CT
Mailing Address - Street 2:
Mailing Address - City:IRMO
Mailing Address - State:SC
Mailing Address - Zip Code:29063-9477
Mailing Address - Country:US
Mailing Address - Phone:803-821-8726
Mailing Address - Fax:
Practice Address - Street 1:2 HOLLY HOCK CT
Practice Address - Street 2:
Practice Address - City:IRMO
Practice Address - State:SC
Practice Address - Zip Code:29063-9477
Practice Address - Country:US
Practice Address - Phone:803-821-8726
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-15
Last Update Date:2020-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC7621101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional