Provider Demographics
NPI:1205668662
Name:RILEY, DYLAN JACOB (RBT)
Entity type:Individual
Prefix:
First Name:DYLAN
Middle Name:JACOB
Last Name:RILEY
Suffix:
Gender:M
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:119 BEST PLACE CT N APT T
Mailing Address - Street 2:
Mailing Address - City:BOONE
Mailing Address - State:NC
Mailing Address - Zip Code:28607-6072
Mailing Address - Country:US
Mailing Address - Phone:704-913-7826
Mailing Address - Fax:
Practice Address - Street 1:207 WINKLERS CREEK RD STE 1
Practice Address - Street 2:
Practice Address - City:BOONE
Practice Address - State:NC
Practice Address - Zip Code:28607-7838
Practice Address - Country:US
Practice Address - Phone:252-751-0518
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-15
Last Update Date:2024-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RBT-24-346540106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician