Provider Demographics
NPI:1245644079
Name:RILEY, ELIZABETH THOMPSON (MS, LPCA)
Entity type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:THOMPSON
Last Name:RILEY
Suffix:
Gender:F
Credentials:MS, LPCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 355
Mailing Address - Street 2:
Mailing Address - City:BLACK CREEK
Mailing Address - State:NC
Mailing Address - Zip Code:27813-0355
Mailing Address - Country:US
Mailing Address - Phone:252-243-4949
Mailing Address - Fax:252-499-9091
Practice Address - Street 1:209 N 35TH ST
Practice Address - Street 2:SUITE A-2
Practice Address - City:MOREHEAD CITY
Practice Address - State:NC
Practice Address - Zip Code:28557-3183
Practice Address - Country:US
Practice Address - Phone:252-499-9087
Practice Address - Fax:252-499-9091
Is Sole Proprietor?:No
Enumeration Date:2014-06-19
Last Update Date:2014-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA10887101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional