Provider Demographics
NPI:1538265533
Name:RIFFLE, WILLIAM ANDREW (MA)
Entity type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:ANDREW
Last Name:RIFFLE
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 9144
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:WV
Mailing Address - Zip Code:25704-0144
Mailing Address - Country:US
Mailing Address - Phone:304-751-1083
Mailing Address - Fax:304-529-7686
Practice Address - Street 1:228 ADAMS AVE
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:WV
Practice Address - Zip Code:25701-1135
Practice Address - Country:US
Practice Address - Phone:304-751-1083
Practice Address - Fax:304-529-7686
Is Sole Proprietor?:No
Enumeration Date:2006-09-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV740103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV11446512OtherCAQHC
WV3810005297Medicaid