Provider Demographics
NPI:1144258518
Name:RILEY, JANE HILL (PH D)
Entity type:Individual
Prefix:DR
First Name:JANE
Middle Name:HILL
Last Name:RILEY
Suffix:
Gender:F
Credentials:PH D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:194 EDGEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:ELKIN
Mailing Address - State:NC
Mailing Address - Zip Code:28621-3202
Mailing Address - Country:US
Mailing Address - Phone:336-526-5860
Mailing Address - Fax:336-526-7485
Practice Address - Street 1:194 EDGEWOOD DR
Practice Address - Street 2:
Practice Address - City:ELKIN
Practice Address - State:NC
Practice Address - Zip Code:28621-3202
Practice Address - Country:US
Practice Address - Phone:336-526-5860
Practice Address - Fax:336-526-7485
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-28
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC796106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6105199Medicaid