Healthcare Provider Details

I. General information

NPI: 1720887482
Provider Name (Legal Business Name): NANCY MARIE RILEE CSAC-S
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/13/2025
Last Update Date: 03/13/2025
Certification Date: 03/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20500 WARRIORS WAY
MILFORD VA
22514-2867
US

IV. Provider business mailing address

205 CHARDONNAY ROAD
WILLIAMSBURG VA
23185
US

V. Phone/Fax

Practice location:
  • Phone: 757-259-5886
  • Fax:
Mailing address:
  • Phone: 757-259-5886
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number0709025986
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: