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Provider Information for 1730462201


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TERRI LILLER MSW, LISW-S, LICDC


Other Names:  
Other Name: 
TENLEY L DAVIS MSW,LISW-S,LICDC

Sex: Female

NPI: 1730462201
Last Updated: 2023-08-15
Certification Date: 2023-08-15

Details

NameValue
NPI1730462201
Enumeration Date2011-09-21
NPI TypeNPI-1 Individual
Sole ProprietorYES
StatusActive
Mailing Address 7 COURT ST STE 260
CANFIELD, OH 44406-1407
United States

Phone: 330-333-9559 | Fax:414-234-0069
 
Primary Practice Address 7 COURT ST STE 260
CANFIELD, OH 44406-1407
United States

Phone: 330-333-9559 | Fax:414-234-0069
 
Secondary Practice Address(es)
Health Information Exchange
Endpoint TypeEndpointEndpoint DescriptionUseContent TypeAffiliationEndpoint Location
Other Identifiers
IssuerStateNumberOther Issuer
MEDICAIDOH0157389
Taxonomy
Primary TaxonomySelected TaxonomyStateLicense Number
No 101YA0400X - Counselor - Addiction (Substance Use Disorder)OH161011
Yes 193200000X - Multi-Specialty Group
1041C0700X - Social Worker - Clinical
OHI1303604-SUPV