Healthcare Provider Details

I. General information

NPI: 1851043269
Provider Name (Legal Business Name): AUTUMN RIFFE LICDC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/26/2022
Last Update Date: 03/14/2023
Certification Date: 03/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1550 SHERIDAN DR STE 302
LANCASTER OH
43130-1380
US

IV. Provider business mailing address

1550 SHERIDAN DR STE 302
LANCASTER OH
43130-1380
US

V. Phone/Fax

Practice location:
  • Phone: 740-901-3046
  • Fax:
Mailing address:
  • Phone: 174-090-1304
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberLICDC.162212
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: