Individual
RILEY EVERSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
224 W D. L. INGRAM AVENUE, BLDG. 1408, CANNON AFB, NM 88103-9365
(850) 797-1153
Mailing address
27TH SOMDG, 224 W D. L. INGRAM AVENUE, BLDG. 1408, CANNON AFB, NM 88103
(850) 797-1153
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
M-10020
NM
1041C0700X
Clinical Social Worker
Primary
M-10852
NM
1041C0700X
Clinical Social Worker
—
—
171M00000X
Case Manager/Care Coordinator
—
—
Other
Enumeration date
09/10/2013
Last updated
07/21/2023
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