Basic Information
Provider Information
NPI: 1033558218
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: RIETH
FirstName: LINDA
MiddleName: SUE
NamePrefix: DR.
NameSuffix:  
Credential: PHD, LPCA, AFC
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 818 CRYSTAL CT SW
Address2:  
City: SHALLOTTE
State: NC
PostalCode: 284705636
CountryCode: US
TelephoneNumber: 9107544515
FaxNumber: 9107547997
Practice Location
Address1: 120 COASTAL HORIZONS DR
Address2:  
City: SHALLOTTE
State: NC
PostalCode: 284706094
CountryCode: US
TelephoneNumber: 9107544515
FaxNumber:  
Other Information
ProviderEnumerationDate: 06/20/2013
LastUpdateDate: 06/20/2013
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
101Y00000XA10251NCY Behavioral Health & Social Service ProvidersCounselor 

No ID Information.


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