Provider Demographics
NPI:1508297458
Name:AU, D. LORI MARIE
Entity Type:Individual
Prefix:MS
First Name:D. LORI
Middle Name:MARIE
Last Name:AU
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:LORI
Other - Middle Name:
Other - Last Name:AU
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCDC-II
Mailing Address - Street 1:310 COLLEGE AVE
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:OH
Mailing Address - Zip Code:44805-3803
Mailing Address - Country:US
Mailing Address - Phone:419-289-7675
Mailing Address - Fax:419-289-2349
Practice Address - Street 1:310 COLLEGE AVE
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:OH
Practice Address - Zip Code:44805-3803
Practice Address - Country:US
Practice Address - Phone:419-289-7675
Practice Address - Fax:419-289-2349
Is Sole Proprietor?:No
Enumeration Date:2013-12-03
Last Update Date:2013-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH021184101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)