Healthcare Provider Details

I. General information

NPI: 1841117231
Provider Name (Legal Business Name): LISA MARIE TERRELL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/06/2026
Last Update Date: 07/06/2026
Certification Date: 07/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4977 NORTHCUTT PL
DAYTON OH
45414-3839
US

IV. Provider business mailing address

1144 DEERFIELD RD UNIT A
LEBANON OH
45036-9214
US

V. Phone/Fax

Practice location:
  • Phone: 800-829-5461
  • Fax:
Mailing address:
  • Phone: 937-944-3862
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCDCA194072
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: