Provider Demographics
NPI:1588345417
Name:RIVERS, TANESHA (LCMHC-A, LCAS-A)
Entity type:Individual
Prefix:
First Name:TANESHA
Middle Name:
Last Name:RIVERS
Suffix:
Gender:F
Credentials:LCMHC-A, LCAS-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2552 ARROWHEAD CIR
Mailing Address - Street 2:
Mailing Address - City:GASTONIA
Mailing Address - State:NC
Mailing Address - Zip Code:28054-1368
Mailing Address - Country:US
Mailing Address - Phone:704-648-2551
Mailing Address - Fax:
Practice Address - Street 1:2552 ARROWHEAD CIR
Practice Address - Street 2:
Practice Address - City:GASTONIA
Practice Address - State:NC
Practice Address - Zip Code:28054-1368
Practice Address - Country:US
Practice Address - Phone:704-648-2551
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-25
Last Update Date:2024-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCLCAS-28837101YA0400X
NCA19476101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)