Basic Information
| Provider Information | |||||||||
| NPI: | 1245887223 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | RIVERA | ||||||||
| FirstName: | CARLA | ||||||||
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| Credential: | MSW, LCSW-A | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5710 OLEANDER DR STE 208 | ||||||||
| Address2: | |||||||||
| City: | WILMINGTON | ||||||||
| State: | NC | ||||||||
| PostalCode: | 284034722 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9104521460 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 5710 OLEANDER DR STE 208 | ||||||||
| Address2: | |||||||||
| City: | WILMINGTON | ||||||||
| State: | NC | ||||||||
| PostalCode: | 284034722 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9104521460 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/23/2019 | ||||||||
| LastUpdateDate: | 08/23/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | P013692 | NC | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.