Provider Demographics
NPI:1710965546
Name:VIOLAND, AUDREY (MSSW LSW)
Entity type:Individual
Prefix:MS
First Name:AUDREY
Middle Name:
Last Name:VIOLAND
Suffix:
Gender:F
Credentials:MSSW LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1320 WOODMAN DR
Mailing Address - Street 2:STE 200
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45432
Mailing Address - Country:US
Mailing Address - Phone:937-223-1781
Mailing Address - Fax:937-853-0096
Practice Address - Street 1:1320 WOODMAN DR
Practice Address - Street 2:STE 200
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45432
Practice Address - Country:US
Practice Address - Phone:937-223-1781
Practice Address - Fax:937-853-0096
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS00120111041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2272231Medicaid