Individual
AVEEAVIS TERRYSEENA BLACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCDCIII , SWCA
Contact information
Practice address
815 SUNNYVIEW AVE, DAYTON, OH 45406-1957
(937) 238-5173
Mailing address
815 SUNNYVIEW AVE, DAYTON, OH 45406-1957
(937) 238-5173
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
111922
OH
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
LCDCIII.021224
OH
1041C0700X
Clinical Social Worker
W.0000977
OH
Other
Enumeration date
01/23/2018
Last updated
01/23/2018
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