Provider Demographics
NPI:1114415304
Name:RIENSCHIELD, DALLAS A (CDCA)
Entity Type:Individual
Prefix:
First Name:DALLAS
Middle Name:A
Last Name:RIENSCHIELD
Suffix:
Gender:F
Credentials:CDCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:117 W MAIN ST STE 107
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:OH
Mailing Address - Zip Code:43130-3799
Mailing Address - Country:US
Mailing Address - Phone:740-689-1890
Mailing Address - Fax:740-689-1890
Practice Address - Street 1:117 W MAIN ST STE 107
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:OH
Practice Address - Zip Code:43130-3799
Practice Address - Country:US
Practice Address - Phone:740-689-1890
Practice Address - Fax:740-689-1890
Is Sole Proprietor?:No
Enumeration Date:2018-04-24
Last Update Date:2018-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCDCA.164791101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH1447519327Medicaid