Provider Demographics
NPI:1336734243
Name:LEMBCKE, RICHARD (CADAC II)
Entity Type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:
Last Name:LEMBCKE
Suffix:
Gender:M
Credentials:CADAC II
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:568 GLENWOOD DR
Mailing Address - Street 2:
Mailing Address - City:VALPARAISO
Mailing Address - State:IN
Mailing Address - Zip Code:46385-8877
Mailing Address - Country:US
Mailing Address - Phone:219-510-2716
Mailing Address - Fax:
Practice Address - Street 1:568 GLENWOOD DR
Practice Address - Street 2:
Practice Address - City:VALPARAISO
Practice Address - State:IN
Practice Address - Zip Code:46385-8877
Practice Address - Country:US
Practice Address - Phone:219-510-2716
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-02
Last Update Date:2021-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
INC2-2006101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty