Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YM0800X | Mental Health Counselor | ||
Y | 101YP1600X | Pastoral Counselor | ||
N | 101YP2500X | Professional Counselor | LPC005480 | GA |
NPI | 1104964675 |
---|---|
Provider Name | Mr. Michael A Rivera |
First Address | Atlanta, GA 30339-2140 |
Second Address | Atlanta, GA 30339-2131 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/02/2007 |
Last Update Date | 20/11/2020 |