Provider Demographics
NPI:1700638640
Name:RIVERS, CHRISTINE MONIQUE AMELIA (RBT)
Entity Type:Individual
Prefix:MRS
First Name:CHRISTINE
Middle Name:MONIQUE AMELIA
Last Name:RIVERS
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:MRS
Other - First Name:MONIQUE
Other - Middle Name:
Other - Last Name:RIVERS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RBT
Mailing Address - Street 1:3854 ROLLINGSFORD CIR
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33810-3863
Mailing Address - Country:US
Mailing Address - Phone:210-685-9974
Mailing Address - Fax:
Practice Address - Street 1:103 S FLORIDA AVE
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33801-4619
Practice Address - Country:US
Practice Address - Phone:813-763-5469
Practice Address - Fax:813-441-8362
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-03
Last Update Date:2024-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician