Provider Demographics
NPI:1134644016
Name:DURHAM, TIMOTHY (LISW-S)
Entity type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:
Last Name:DURHAM
Suffix:
Gender:M
Credentials:LISW-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:44 SHADY LN
Mailing Address - Street 2:
Mailing Address - City:GRANVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43023-9281
Mailing Address - Country:US
Mailing Address - Phone:740-739-2903
Mailing Address - Fax:
Practice Address - Street 1:905 RIVER RD
Practice Address - Street 2:
Practice Address - City:GRANVILLE
Practice Address - State:OH
Practice Address - Zip Code:43023-9560
Practice Address - Country:US
Practice Address - Phone:740-507-6707
Practice Address - Fax:740-739-2906
Is Sole Proprietor?:No
Enumeration Date:2017-08-11
Last Update Date:2017-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI-000862-S1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical