Provider Demographics
NPI:1538603725
Name:RIVERSIDE COUNSELING & CONSULTING
Entity type:Organization
Organization Name:RIVERSIDE COUNSELING & CONSULTING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/COUNSELOR
Authorized Official - Prefix:MS
Authorized Official - First Name:DEBBIE
Authorized Official - Middle Name:
Authorized Official - Last Name:GIBSON
Authorized Official - Suffix:
Authorized Official - Credentials:LPC, SLPC
Authorized Official - Phone:256-340-0300
Mailing Address - Street 1:106 LEE STREET NE
Mailing Address - Street 2:SUITE C
Mailing Address - City:DECATUR
Mailing Address - State:AL
Mailing Address - Zip Code:35601-1760
Mailing Address - Country:US
Mailing Address - Phone:256-340-0300
Mailing Address - Fax:256-340-0353
Practice Address - Street 1:106 LEE STREET NE
Practice Address - Street 2:SUITE C
Practice Address - City:DECATUR
Practice Address - State:AL
Practice Address - Zip Code:35601-1760
Practice Address - Country:US
Practice Address - Phone:256-340-0300
Practice Address - Fax:256-340-0353
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-07
Last Update Date:2016-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL3642101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty