Provider Demographics
NPI:1629476395
Name:RIVERS, CARMITA (LPC)
Entity type:Individual
Prefix:
First Name:CARMITA
Middle Name:
Last Name:RIVERS
Suffix:
Gender:F
Credentials:LPC
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 957676
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:GA
Mailing Address - Zip Code:30095-9528
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2795 MAIN STREET WEST
Practice Address - Street 2:SUITE 19B
Practice Address - City:SNELLVILLE
Practice Address - State:GA
Practice Address - Zip Code:30078-3072
Practice Address - Country:US
Practice Address - Phone:404-671-5895
Practice Address - Fax:770-674-7854
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-12
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YP2500X
GA008191101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional