Provider Demographics
NPI:1154006286
Name:DIIENNO, RICHARD (CDCA)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:
Last Name:DIIENNO
Suffix:
Gender:M
Credentials:CDCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1609 KERRYGLEN DR
Mailing Address - Street 2:
Mailing Address - City:GALLOWAY
Mailing Address - State:OH
Mailing Address - Zip Code:43119-9038
Mailing Address - Country:US
Mailing Address - Phone:614-897-4959
Mailing Address - Fax:
Practice Address - Street 1:1609 KERRYGLEN DR
Practice Address - Street 2:
Practice Address - City:GALLOWAY
Practice Address - State:OH
Practice Address - Zip Code:43119-9038
Practice Address - Country:US
Practice Address - Phone:614-897-4959
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-16
Last Update Date:2023-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH182692101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)