Individual
MRS. NINA L RIVENBARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPC, LCAS
Contact information
Practice address
3963 MARKET STREET, SUITE A, WILMINGTON, NC 28403-1488
(910) 362-9474
(910) 362-9192
Mailing address
3963 MARKET STREET, SUITE A, WILMINGTON, NC 28403-1488
(910) 362-9474
(910) 362-9192
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
3568
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
143Y9
BCBS
NC
05
—
6102512
—
NC
Enumeration date
10/04/2006
Last updated
07/08/2007
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