Provider Demographics
NPI:1962256024
Name:RIVERBEND INTEGRATIVE THERAPY LLC
Entity type:Organization
Organization Name:RIVERBEND INTEGRATIVE THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:
Authorized Official - Last Name:JENKINS
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:508-326-9929
Mailing Address - Street 1:PO BOX 2406
Mailing Address - Street 2:
Mailing Address - City:PETERSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:23804-2406
Mailing Address - Country:US
Mailing Address - Phone:804-760-8323
Mailing Address - Fax:508-433-1871
Practice Address - Street 1:561 HIGH ST
Practice Address - Street 2:
Practice Address - City:PETERSBURG
Practice Address - State:VA
Practice Address - Zip Code:23803-3859
Practice Address - Country:US
Practice Address - Phone:804-760-8323
Practice Address - Fax:508-433-1871
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-15
Last Update Date:2024-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty