Provider Demographics
NPI:1528439031
Name:RIVERS, VONDA V (LPC)
Entity type:Individual
Prefix:
First Name:VONDA
Middle Name:V
Last Name:RIVERS
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19815 BAY BRANCH RD
Mailing Address - Street 2:
Mailing Address - City:ANDALUSIA
Mailing Address - State:AL
Mailing Address - Zip Code:36420-9234
Mailing Address - Country:US
Mailing Address - Phone:334-222-2523
Mailing Address - Fax:
Practice Address - Street 1:2861 NEIL METCALF RD
Practice Address - Street 2:
Practice Address - City:ENTERPRISE
Practice Address - State:AL
Practice Address - Zip Code:36330-8003
Practice Address - Country:US
Practice Address - Phone:334-347-0212
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-10-09
Last Update Date:2015-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL3400101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL630588470OtherEIN 630588470