Provider Demographics
NPI:1992191530
Name:RILEY, JENNIFER B (LCSW)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:B
Last Name:RILEY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:123 HENDERSONVILLE RD
Mailing Address - Street 2:
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28803-2868
Mailing Address - Country:US
Mailing Address - Phone:828-257-4730
Mailing Address - Fax:828-257-4738
Practice Address - Street 1:950 TUNNEL RD
Practice Address - Street 2:
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28805-2025
Practice Address - Country:US
Practice Address - Phone:828-707-2335
Practice Address - Fax:828-537-1551
Is Sole Proprietor?:No
Enumeration Date:2015-04-10
Last Update Date:2021-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0105811041C0700X
NCP0102681041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1992191530Medicaid
NCC010581OtherLCSW LICENSE