Individual
MR. KENNETH WILLIAM RILEY JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
10953 PARK RD., CHARLOTTE, NC 28226
(910) 624-7983
Mailing address
525 N TRYON ST STE 1600, CHARLOTTE, NC 28202-0213
(855) 832-6727
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7301435
—
NC
Enumeration date
05/31/2018
Last updated
04/13/2021
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