Organization Name: | RIVERSIDE COUNSELING SERVICES, LLC |
NPI Number: | 1003198409 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | TIMOTHY THEIN (EXECUTIVE DIRECTOR) |
Mailing Address: | 1301 W Eau Gallie Blvd Suite 105 Melbourne |
State: | FL US |
Postal Code: | 329355390 |
Phone Number: | 3214216992 |
Fax Number: | 3214216993 |
NPI Enumeration Date: | 09/13/2011 |
NPI Last Update Date: | 01/08/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 1041C0700X |
License Number: | SW9134 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | FL |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Social Worker |
Taxonomy Specialization: | Clinical |
Taxonomy Definition: | A social worker who holds a master |