Provider Demographics
NPI:1578261814
Name:ADULARESCENCE, TEVIS DORRELL (PEER SUPPORT)
Entity Type:Individual
Prefix:MR
First Name:TEVIS
Middle Name:DORRELL
Last Name:ADULARESCENCE
Suffix:
Gender:M
Credentials:PEER SUPPORT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1228 WALNUT ST APT 2
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45202-7135
Mailing Address - Country:US
Mailing Address - Phone:513-913-6148
Mailing Address - Fax:
Practice Address - Street 1:1228 WALNUT ST
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45202-7135
Practice Address - Country:US
Practice Address - Phone:513-913-6148
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-16
Last Update Date:2023-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist
No374700000XNursing Service Related ProvidersTechnician
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
No172V00000XOther Service ProvidersCommunity Health Worker
No372500000XNursing Service Related ProvidersChore Provider
No372600000XNursing Service Related ProvidersAdult Companion
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician