MEDICARE: SABRINA ANN RILEY LCDCII.161523

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YA0400X	Addiction (Substance Use Disorder) Counselor	LCDCII.161523	OH

General Provider Information

NPI Number	:	1659879880
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SABRINA ANN RILEY LCDCII.161523

Provider Business Mailing Address
First Line	:	20 LIVINGSTON AVE
Second Line	:
City	:	DAYTON
State	:	OH
Zip	:	45403-2938
Country	:	US
Telephone Number	:	866-738-1003
Fax Number	:

Provider Business Practice Location Address
First Line	:	20 LIVINGSTON AVE
Second Line	:
City	:	DAYTON
State	:	OH
Zip	:	45403-2938
Country	:	US
Telephone Number	:	937-387-6395
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/23/2018
Last Update Date	:	07/27/2022

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