Provider Demographics
NPI:1659879880
Name:RILEY, SABRINA ANN (LCDCII161523)
Entity Type:Individual
Prefix:
First Name:SABRINA
Middle Name:ANN
Last Name:RILEY
Suffix:
Gender:F
Credentials:LCDCII161523
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 LIVINGSTON AVE
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45403-2938
Mailing Address - Country:US
Mailing Address - Phone:866-738-1003
Mailing Address - Fax:
Practice Address - Street 1:20 LIVINGSTON AVE
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45403-2938
Practice Address - Country:US
Practice Address - Phone:937-387-6395
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-23
Last Update Date:2022-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHLCDCII.161523101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)