Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1041C0700X | Clinical Social Worker | 3831C | AL |
Y | 1041C0700X | Clinical Social Worker | C8089 | MS |
NPI | 1003267444 |
---|---|
Provider Name | Shelia Rivers |
First Address | Gulfport, MS 39507-1922 |
Second Address | Gulfport, MS 39507 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/06/2016 |
Last Update Date | 13/08/2019 |