Provider Demographics
NPI:1376003533
Name:RIEGE, YVONNE RENEE (LCAC)
Entity Type:Individual
Prefix:
First Name:YVONNE
Middle Name:RENEE
Last Name:RIEGE
Suffix:
Gender:F
Credentials:LCAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:114 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:GOSHEN
Mailing Address - State:IN
Mailing Address - Zip Code:46526-3207
Mailing Address - Country:US
Mailing Address - Phone:574-533-6154
Mailing Address - Fax:574-534-3951
Practice Address - Street 1:114 N MAIN ST
Practice Address - Street 2:
Practice Address - City:GOSHEN
Practice Address - State:IN
Practice Address - Zip Code:46526-3207
Practice Address - Country:US
Practice Address - Phone:574-533-6154
Practice Address - Fax:574-534-3951
Is Sole Proprietor?:No
Enumeration Date:2019-03-23
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN87001382A101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN87001382AOtherLICENSE NUMBER INDIANA