Provider Demographics
NPI:1679978571
Name:TERESA N. FEARS LLC
Entity Type:Organization
Organization Name:TERESA N. FEARS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:TERESA
Authorized Official - Middle Name:NA'MORE
Authorized Official - Last Name:FEARS
Authorized Official - Suffix:
Authorized Official - Credentials:LICDC
Authorized Official - Phone:937-274-4369
Mailing Address - Street 1:1 ELIZABETH PL STE 1180
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45417-3445
Mailing Address - Country:US
Mailing Address - Phone:937-274-4369
Mailing Address - Fax:
Practice Address - Street 1:1 ELIZABETH PL STE 1180
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45417-3445
Practice Address - Country:US
Practice Address - Phone:937-274-4369
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-04
Last Update Date:2014-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH201412600828261QR0405X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder