Provider Demographics
NPI:1053093989
Name:RILEY, DEBRA NICOLE (LISW-CP)
Entity type:Individual
Prefix:
First Name:DEBRA
Middle Name:NICOLE
Last Name:RILEY
Suffix:
Gender:F
Credentials:LISW-CP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:831 LUCAS ST APT E
Mailing Address - Street 2:
Mailing Address - City:ROCK HILL
Mailing Address - State:SC
Mailing Address - Zip Code:29730-4177
Mailing Address - Country:US
Mailing Address - Phone:803-347-7828
Mailing Address - Fax:
Practice Address - Street 1:291 WILLOWBROOK AVE STE 102
Practice Address - Street 2:
Practice Address - City:ROCK HILL
Practice Address - State:SC
Practice Address - Zip Code:29730-4236
Practice Address - Country:US
Practice Address - Phone:803-347-7828
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-01
Last Update Date:2023-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC155221041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical