Provider Demographics
NPI:1366063877
Name:RILEY, DAWN (MFT)
Entity type:Individual
Prefix:
First Name:DAWN
Middle Name:
Last Name:RILEY
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6699 FOX CENTRE PKWY
Mailing Address - Street 2:
Mailing Address - City:GLOUCESTER
Mailing Address - State:VA
Mailing Address - Zip Code:23061-6134
Mailing Address - Country:US
Mailing Address - Phone:804-832-0747
Mailing Address - Fax:
Practice Address - Street 1:6699 FOX CENTRE PKWY
Practice Address - Street 2:
Practice Address - City:GLOUCESTER
Practice Address - State:VA
Practice Address - Zip Code:23061-6134
Practice Address - Country:US
Practice Address - Phone:804-832-0747
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-06
Last Update Date:2021-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0717001556101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty