Provider Demographics
NPI:1306591631
Name:RIVERS, MARICO DANTEL
Entity type:Individual
Prefix:
First Name:MARICO
Middle Name:DANTEL
Last Name:RIVERS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1408 STRAWBERRY LN APT 313
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76011-4962
Mailing Address - Country:US
Mailing Address - Phone:972-854-9497
Mailing Address - Fax:
Practice Address - Street 1:600 W PARK ROW DR STE A
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76010-2559
Practice Address - Country:US
Practice Address - Phone:817-987-2651
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-15
Last Update Date:2022-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)