Provider Demographics
NPI:1164910451
Name:SEDON, THERESE ANNE
Entity Type:Individual
Prefix:
First Name:THERESE
Middle Name:ANNE
Last Name:SEDON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:THERESE
Other - Middle Name:ANNE
Other - Last Name:LORSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CDCA
Mailing Address - Street 1:625 CLEVELAND AVE NW
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44702-1805
Mailing Address - Country:US
Mailing Address - Phone:330-455-0374
Mailing Address - Fax:330-453-6716
Practice Address - Street 1:1711 SPRING AVE NE
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44714-2349
Practice Address - Country:US
Practice Address - Phone:330-454-6800
Practice Address - Fax:330-588-7176
Is Sole Proprietor?:No
Enumeration Date:2018-04-23
Last Update Date:2018-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCDCA166669101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)