Provider Demographics
NPI:1598324964
Name:AVILA-JOHN, ALAN (LPC, LICDC, CRC)
Entity Type:Individual
Prefix:MR
First Name:ALAN
Middle Name:
Last Name:AVILA-JOHN
Suffix:
Gender:M
Credentials:LPC, LICDC, CRC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8369 WOODGROVE CT
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45458-1824
Mailing Address - Country:US
Mailing Address - Phone:937-321-5220
Mailing Address - Fax:
Practice Address - Street 1:660 S MAIN ST
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45402-2708
Practice Address - Country:US
Practice Address - Phone:937-461-4800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-10
Last Update Date:2019-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHC1700256101YM0800X
OHLICDC.161793101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHLPCMedicaid