Provider Demographics
NPI:1285484014
Name:RIZER, KAITLYN MARIE (QBA)
Entity type:Individual
Prefix:MRS
First Name:KAITLYN
Middle Name:MARIE
Last Name:RIZER
Suffix:
Gender:F
Credentials:QBA
Other - Prefix:
Other - First Name:KAITLYN
Other - Middle Name:MARIE
Other - Last Name:LARSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3920 PENSACOLA DR
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27834-9630
Mailing Address - Country:US
Mailing Address - Phone:252-665-4871
Mailing Address - Fax:
Practice Address - Street 1:102 SCALES PL
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27834-7202
Practice Address - Country:US
Practice Address - Phone:252-665-4871
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-25
Last Update Date:2024-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty