Provider Demographics
NPI:1174076350
Name:ALLDREDGE, TIMOTHY (LPCC-S)
Entity type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:
Last Name:ALLDREDGE
Suffix:
Gender:M
Credentials:LPCC-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1587 LITTLE FALLS DR
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45458-9706
Mailing Address - Country:US
Mailing Address - Phone:317-242-9208
Mailing Address - Fax:
Practice Address - Street 1:2211 ARBOR BLVD
Practice Address - Street 2:
Practice Address - City:MORAINE
Practice Address - State:OH
Practice Address - Zip Code:45439-1521
Practice Address - Country:US
Practice Address - Phone:937-222-9481
Practice Address - Fax:937-222-3710
Is Sole Proprietor?:No
Enumeration Date:2016-07-25
Last Update Date:2020-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHC.1500509101YA0400X, 101YM0800X
OHE.1901094101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)