Provider Demographics
NPI:1881066033
Name:RILEY, STEVEN SR (LPCA)
Entity type:Individual
Prefix:MR
First Name:STEVEN
Middle Name:
Last Name:RILEY
Suffix:SR
Gender:M
Credentials:LPCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3624 MELROSE DR
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27604-3815
Mailing Address - Country:US
Mailing Address - Phone:919-720-5196
Mailing Address - Fax:
Practice Address - Street 1:3624 MELROSE DR.
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27604-3815
Practice Address - Country:US
Practice Address - Phone:919-720-5196
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-28
Last Update Date:2015-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA11940101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional