Provider Demographics
NPI:1760265409
Name:AVILA, RICHARD ALFONSO (MA, LPCC)
Entity Type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:ALFONSO
Last Name:AVILA
Suffix:
Gender:M
Credentials:MA, LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:534 ILLINOIS CT
Mailing Address - Street 2:
Mailing Address - City:WESTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43081-3014
Mailing Address - Country:US
Mailing Address - Phone:973-306-8486
Mailing Address - Fax:
Practice Address - Street 1:450 ALKYRE RUN STE 250
Practice Address - Street 2:
Practice Address - City:WESTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:43082-6076
Practice Address - Country:US
Practice Address - Phone:614-705-2585
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-16
Last Update Date:2023-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE.2303632101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health