Provider Demographics
NPI:1649461773
Name:RILEY, LANETTA MARIE
Entity type:Individual
Prefix:MS
First Name:LANETTA
Middle Name:MARIE
Last Name:RILEY
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:LANETTA
Other - Middle Name:MARIE
Other - Last Name:RILEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4539 E 7TH AVE APT 2
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99508-2746
Mailing Address - Country:US
Mailing Address - Phone:907-332-0535
Mailing Address - Fax:
Practice Address - Street 1:1569 BRAGAW ST
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508-3109
Practice Address - Country:US
Practice Address - Phone:907-333-4343
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-05
Last Update Date:2018-11-21
Deactivation Date:2018-10-15
Deactivation Code:
Reactivation Date:2018-11-21
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health