Provider Demographics
NPI:1932521234
Name:BRINSON, THERESSA LYNN (MRC, LICDC, ICADC)
Entity Type:Individual
Prefix:MS
First Name:THERESSA
Middle Name:LYNN
Last Name:BRINSON
Suffix:
Gender:F
Credentials:MRC, LICDC, ICADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7071 CORPORATE WAY
Mailing Address - Street 2:SUITE #105
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45459-8911
Mailing Address - Country:US
Mailing Address - Phone:937-416-1088
Mailing Address - Fax:
Practice Address - Street 1:7071 CORPORATE WAY
Practice Address - Street 2:SUITE #105
Practice Address - City:CENTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:45459-8911
Practice Address - Country:US
Practice Address - Phone:937-416-1088
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-06
Last Update Date:2014-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X, 101YM0800X, 106H00000X
OH081100101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist