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General NPI Number Information
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NPI Number | 1447997630
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Entity Type | Individual
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Provider Name | RACHEL NICOLE LISLE CASE MANAGER
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Gender | Female
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Dates
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Enumeration Date | 05/18/2022
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Last Update Date | 05/18/2022
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Provider Practice Location Address
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Address Line | 5563 FAR HILLS AVE
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City | DAYTON
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State | OH
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Zip | 45429-2225
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Country | US
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Telephone | 937-231-2300
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Fax |
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Provider Business Mailing Address
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Address Line | 2909 WYLIE DR
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City | FAIRBORN
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State | OH
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Zip | 45324-2239
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Country | US
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Telephone | 937-797-5120
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number |
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License Number State |
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