MEDICARE: DANIELLE ALICIA-DANTE OLNEY-DIEHL LICDC, QMHS, TTS

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.161431	OH
2	101YA0400X	Addiction (Substance Use Disorder) Counselor	LICDC.162174	OH
3	101YM0800X	Mental Health Counselor	LICDC.162174	OH

General Provider Information

NPI Number	:	1982192944
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DANIELLE ALICIA-DANTE OLNEY-DIEHL LICDC, QMHS, TTS

Provider Business Mailing Address
First Line	:	400 BOWMAN ST
Second Line	:
City	:	MANSFIELD
State	:	OH
Zip	:	44903-1235
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	839 E MARKET ST STE 126
Second Line	:
City	:	AKRON
State	:	OH
Zip	:	44305-2460
Country	:	US
Telephone Number	:	330-338-6174
Fax Number	:	888-954-3777

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

Provider Enumeration Date	:	04/25/2018
Last Update Date	:	02/09/2024

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