Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP2500X | Professional Counselor | 37PC00498100 |
NPI | 1003412388 |
---|---|
Provider Name | Alexandria Riley |
First Address | West Orange, NJ 07052-4165 |
Second Address | West Orange, NJ 07052-4165 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/12/2020 |
Last Update Date | 10/12/2020 |