Board Appointment Data Sheet

BOARD APPOINTMENT DATA SHEET

List all members – use additional pages as needed. This form can be printed and completed, or wordprocessed for electronic transfer via e-mail. If wordprocessed, replace the appropriate checkbox with an “X.”

Board Name
JEFFERSON COUNTY PREVENTION AND RECOVERY BOARD / Date Prepared
04/06/10
Board Member
BLACK, REBECCA / Appointment Sex Ethnic Group
 ODMH Male  African-American
 DADAS X Female  Hispanic
X County  Alaskan Native
 Asian or Pacific Islander
OFFICER  Native American
 Other
Representation: select all that apply:
Mental Health Alcohol/Drug Addiction
 Consumer  Consumer
 Family Member  Family Member
 MH Professional  Professional
 Psychiatrist  Advocate
 Other Physician
Mailing Address (street, city, state, zip)
1454 US RT 250
ADENA OHIO 43901
Telephone (include area code)
740.546-3740 / County of Residence
JEFFERSON
Occupation
SELF EMPLOYED
Term
FIRST / Year Term Expires
06/30/12
Board Name
JEFFERSON COUNTY PREVENTION AND RECOVERY BOARD / Date Prepared
04/06/10
Board Member
GERALD J. ANDERSON / Appointment Sex Minority
 ODMH X Male  African-American
X ODADAS  Female  Hispanic
 County  Alaskan Native
 Asian or Pacific Islander
OFFICER  Native American
 Other
Representation: select all that apply
Mental Health Alcohol/Drug Addiction
 Consumer  Consumer
 Family Member X Family Member
 MH Professional  Professional
 Psychiatrist  Advocate
 Physician
Mailing Address (street, city, state, zip)
479 TOWNSHIP HWY 108A
ADENA OH 43901
Telephone (include area code)
740.546.3274 / County of Residence
JEFFERSON
Occupation
RETIRED
TERM
FIRST / Year Term Expires
06/30/12
Board Name
JEFFERSON COUNTY PREVENTION AND RECOVERY BOARD / Date Prepared
04/06/10
Board Member
SANFORD W. BERMAN / Appointment Sex Minority
 ODMH X Male  African-American
 DADAS  Female  Hispanic
X County  Alaskan Native
 Asian or Pacific Islander
OFFICER  Native American
 Other
Representation: select all that apply
Mental Health Alcohol/Drug Addiction
 Consumer  Consumer
 Family Member  Family Member
 MH Professional  Professional
 Psychiatrist  Advocate
 Physician
Mailing Address (street, city, state, zip)
1809 WILLIAMS PLACE
STEUBENVILLE OH 43952
Telephone (include area code)
7402829736 / County of Residence
JEFFERSON
Occupation
REAL ESTATE AGENT
TERM
SECOND / Year Term Expires
06/30/12
Board Name
JEFFERSON COUNTY PREVENTION AND RECOVERY BOARD / Date Prepared
04/06/10
Board Member
STEVE WILSON / Appointment Sex Minority
 ODMH X Male X African-American
X ODADAS  Female  Hispanic
 County  Alaskan Native
 Asian or Pacific Islander
OFFICER  Native American
CHAIRMAN  Other
Representation: select all that apply
Mental Health Alcohol/Drug Addiction
 Consumer X Consumer
 Family Member  Family Member
 MH Professional Professional
 Psychiatrist  Advocate
 Physician
Mailing Address (street, city, state, zip)
124 Shirley Circle
Steubenville OH 43952
Telephone (include area code)
740.282.0043 / County of Residence
JEFFERSON
Occupation
MILL WORKER
TERM
SECOND / Year Term Expires
06/30/12

DMH-0164 DMH-ADM

Board Name
JEFFERSON COUNTY PREVENTION AND RECOVERY BOARD / Date Prepared
04/06/10
Board Member
PAUL MOORE / Appointment Sex Minority
X ODMH X Male  African-American
 DADAS  Female  Hispanic
 County  Alaskan Native
 Asian or Pacific Islander
OFFICER  Native American
 Other
Representation: select all that apply
Mental Health Alcohol/Drug Addiction
X Consumer  Consumer
 Family Member  Family Member
 MH Professional  Professional
 Psychiatrist  Advocate
 Physician
Mailing Address (street, city, state, zip)
80 TWP RD 250
RICHMOND OH 43944
Telephone (include area code)
740.7659001 / County of Residence
JEFFERSON
Occupation
RETIRED
TERM
SECOND / Year Term Expires
06/30/12
Board Name
JEFFERSON COUNTY PREVENTION AND RECOVERY BOARD / Date Prepared
04/06/10
Board Member
DIANE JULIO / Appointment Sex Minority
 ODMH  Male African-American
X ODADAS X Female  Hispanic
County  Alaskan Native
 Asian or Pacific Islander
OFFICER  Native American
 Other
Representation: select all that apply
Mental Health Alcohol/Drug Addiction
 Consumer  Consumer
 Family Member X Family Member
 MH Professional  Professional
 Psychiatrist  Advocate
 Physician
Mailing Address (street, city, state, zip)
502 Fernwood Drive
Toronto OH 43964
Telephone (include area code)
740. 283-8614 / County of Residence
JEFFERSON
Occupation
Program Director-County Waste Authority
TERM
FIRST - FULL / Year Term Expires
06/30/15
Board Name
JEFFERSON COUNTY PREVENTION & RECOVERY board / Date Prepared
04/06/10
Board Member
MARY MIHAYLO / Appointment Sex Minority
ODMH  Male  African-American
 DADAS X Female  Hispanic
X County  Alaskan Native
 Asian or Pacific Islander
OFFICER  Native American
V. CHAIRMAN  Other
Representation: select all that apply
Mental Health Alcohol/Drug Addiction
 Consumer  Consumer
 Family Member  Family Member
 MH Professional  Professional
 Psychiatrist  Advocate
 Physician
Mailing Address (street, city, state, zip)
946 BROADWAY BLVD
STEUBENVILLE OH 43952
Telephone (include area code)
740-828-7867 / County of Residence
JEFFERSON
Occupation
RETIRED
TERM
SECOND / Year Term Expires
06/30/12
Board Name
JEFFERSON COUNTY PREVENTION AND RECOVERY BOARD / Date Prepared
04/06/10
Board Member
LARRY YANDA / Appointment Sex Minority
X ODMH X Male  African-American
 DADAS  Female  Hispanic
County  Alaskan Native
 Asian or Pacific Islander
OFFICER  Native American
 Other
Representation: select all that apply
Mental Health Alcohol/Drug Addiction
 Consumer  Consumer
 Family Member  Family Member
X MH Professional  Professional
 Psychiatrist  Advocate
 Physician
Mailing Address (street, city, state, zip)
593 Juanita Street
Steubenville OH 43952
Telephone (include area code)
740-282-4153 / County of Residence
JEFFERSON
Occupation
COUNSELOR
TERM
FIRST / Year Term Expires
06/30/12
Board Name
JEFFERSON COUNTY PREVENTION AND RECOVERY BOARD / Date Prepared
04/06/10
Board Member
DOUGLAS KNIGHT / Appointment Sex Minority
ODMH X Male  African-American
 DADAS Female  Hispanic
X County  Alaskan Native
 Asian or Pacific Islander
OFFICER  Native American
 Other
Representation: select all that apply
Mental Health Alcohol/Drug Addiction
 Consumer  Consumer
 Family Member  Family Member
MH Professional  Professional
Psychiatrist  Advocate
 Physician
Mailing Address (street, city, state, zip)
131 Vireo Drive
Steubenville OH 43952
Telephone (include area code)
740. 792-1966 / County of Residence
JEFFERSON
Occupation
JUVENILE COURT ADMINISTTRATOR
TERM
FIRST / Year Term Expires
06/30/12
Board Name
JEFFERSON COUNTY PREVENTION AND RECOVERY BOARD / Date Prepared
04/06/10
Board Member
BRANIFF-HALL, ROSE ANN / Appointment Sex Minority
 ODMH Male African-American
 ODADAS X Female  Hispanic
X County  Alaskan Native
 Asian or Pacific Islander
OFFICER  Native American
SECRETARY  Other
Representation: select all that apply
Mental Health Alcohol/Drug Addiction
 Consumer  Consumer
 Family Member  Family Member
 MH Professional  Professional
 Psychiatrist  Advocate
 Physician
Mailing Address (street, city, state, zip)
103 MERIDIAN WAY APT D.
WINTERSVILLE OH 43952
Telephone (include area code)
740.275.4202 / County of Residence
JEFFERSON
Occupation
RETIRED
TERM
SECOND / Year Term Expires
06/30/14
Board Name
JEFFERSON COUNTY PREVENTION AND RECOVERY BOARD / Date Prepared
04/06/10
Board Member
DAVID ZATTA / Appointment Sex Minority
ODMH X Male  African-American
 DADAS Female  Hispanic
X County  Alaskan Native
 Asian or Pacific Islander
OFFICER  Native American
 Other
Representation: select all that apply
Mental Health Alcohol/Drug Addiction
 Consumer  Consumer
Family Member  Family Member
 MH Professional  Professional
 Psychiatrist  Advocate
 Physician
Mailing Address (street, city, state, zip)
1802 Hamilton Place
Steubenville OH 43952
Telephone (include area code)
740. 283-1040 / County of Residence
JEFFERSON
Occupation
CPA
TERM
SECOND / Year Term Expires
06/30/12
Board Name
JEFFERSON COUNTY PREVENTION AND RECOVERY BOARD / Date Prepared
04/06/10
Board Member
ALLEN, CRAIG / Appointment Sex Minority
 ODMH X Male  African-American
 DADAS  Female  Hispanic
X County  Alaskan Native
 Asian or Pacific Islander
OFFICER  Native American
PARLIMENTARIAN  Other
Representation: select all that apply
Mental Health Alcohol/Drug Addiction
 Consumer  Consumer
 Family Member  Family Member
 MH Professional  Professional
 Psychiatrist  Advocate
 Physician
Mailing Address (street, city, state, zip)
1117 FEDERAL STREET
TORONTO OH 43964
Telephone (include area code)
740.2829746 / County of Residence
JEFFERSON
Occupation
ATTORNEY
TERM
SECOND / Year Term Expires
06/30/14
Board Name
JEFFERSON COUNTY PREVENTION AND RECOVERY BOARD / Date Prepared
04/06/10
Board Member
LONG, DR. CHRISTOPHER / Appointment Sex Minority
 ODMH X Male  African-American
X ODADAS Female  Hispanic
 County  Alaskan Native
 Asian or Pacific Islander
OFFICER  Native American
 Other
Representation: select all that apply
Mental Health Alcohol/Drug Addiction
 Consumer  Consumer
 Family Member  Family Member
 MH Professional  Professional
 Psychiatrist X Advocate
 Physician
Mailing Address (street, city, state, zip)
308 ANTHONY DRIVE
WINTERSVILLE OH 43952
Telephone (include area code)
740.264.7148 / County of Residence
JEFFERSON
Occupation
OPTOMETRIST
TERM
FIRST / Year Term Expires
06/30/13
Board Name
JEFFERSON COUNTY PREVENTION AND RECOVERY BOARD / Date Prepared
04/06/10
Board Member
URAM, MSGR. KENNETH / Appointment Sex Minority
 ODMH X Male  African-American
 DADAS  Female  Hispanic
X County  Alaskan Native
 Asian or Pacific Islander
 Chairperson  Native American
 Other
Representation: select all that apply
Mental Health Alcohol/Drug Addiction
 Consumer  Consumer
 Family Member  Family Member
 MH Professional  Professional
 Psychiatrist  Advocate
 Physician
Mailing Address (street, city, state, zip)
231 WOODRIDGE DRIVE APT A 303
WINTERSVILLE OH 43953
Telephone (include area code)
740.284-9600 / County of Residence
JEFFERSON
Occupation
RETIRED PRIEST
TERM
SECOND / Year Term Expires
06/30/14
Board Name
JEFFERSON COUNTY PREVENTION AND RECOVERY BOARD / Date Prepared
04/06/10
Board Member
LARRY LEVI / Appointment Sex Minority
x ODMH X Male  African-American
 DADAS  Female  Hispanic
County  Alaskan Native
 Asian or Pacific Islander
 Chairperson  Native American
 Other
Representation: select all that apply
Mental Health Alcohol/Drug Addiction
 Consumer  Consumer
 Family Member  Family Member
 MH Professional  Professional
 Psychiatrist  Advocate
 Physician
Mailing Address (street, city, state, zip)
220 OHIO STREET
TILTONSVILLE OH 43963
Telephone (include area code)
740.859-4542 / County of Residence
JEFFERSON
Occupation
TEACHER - RETIRED
TERM
SECOND / Year Term Expires
06/30/13
Board Name
JEFFERSON COUNTY PREVENTION AND RECOVERY BOARD / Date Prepared
04/06/10
Board Member
DR. FRANK J. PETROLA / Appointment Sex Minority
 ODMH X Male  African-American
DADAS  Female  Hispanic
X County  Alaskan Native
 Asian or Pacific Islander
 Chairperson  Native American
 Other
Representation: “X” Only One
Mental Health Alcohol/Drug Addiction
 Consumer Consumer
 Family Member  Family Member
 MH Professional  Professional
 Psychiatrist  Advocate
X Physician
Mailing Address (street, city, state, zip)
114 Brady Circle
Steubenville OH 43952
Telephone (include area code)
740.283-4773 / County of Residence
JEFFERSON
Occupation
PHYSICIAN
TERM
FIRST / Year Term Expires
06/30/13
Board Name
JEFFERSON COUNTY PREVENTION & RECOVERY BOARD / Date Prepared
04/06/10
Board Member
FLORAK, DR. EDWARD / Appointment Sex Minority
 ODMH  Male  African-American
X ODADAS  Female  Hispanic
 County  Alaskan Native
 Asian or Pacific Islander
OFFICER  Native American
 Other
Representation: select all that apply
Mental Health Alcohol/Drug Addiction
 Consumer  Consumer
 Family Member  Family Member
 MH Professional X Professional
 Psychiatrist  Advocate
 Physician
Mailing Address (street, city, state, zip)
434 SCENIC DRIVE
STEUBENVILLE OHIO 43952
Telephone (include area code)
740.264.4985 / County of Residence
JEFFERSON
Occupation
SELF EMPLOYED
TERM
SECOND / Year Term Expires
06/30/13
Board Name
JEFFERSON COUNTY PREVENTION & RECOVERY BOARD / Date Prepared
04/06/10
Board Member
DANIEL PINCIARO / Appointment Sex Minority
X ODMH X  Male  African-American
 DADAS  Female  Hispanic
County  Alaskan Native
 Asian or Pacific Islander
OFFICER  Native American
Other
Representation: select all that apply
Mental Health Alcohol/Drug Addiction
 Consumer  Consumer
X Family Member  Family Member
 MH Professional  Professional
 Psychiatrist  Advocate
 Physician
Mailing Address (street, city, state, zip)
234 DELWOOD STREET
STEUBENVILLE OH 43952
Telephone (include area code)
740.632-2662 / County of Residence
JEFFERSON
Occupation
DIRECTOR OF HOUSING PROGRAMS
TERM
FIRST / Year Term Expires
06/30/15
Board Name / Date Prepared
Board Member / Appointment Sex Minority
 ODMH  Male  African-American
 DADAS  Female  Hispanic
 County  Alaskan Native
 Asian or Pacific Islander
 Chairperson  Native American
 Other
Representation: “X” Only One
Mental Health Alcohol/Drug Addiction
 Consumer  Consumer
 Family Member  Family Member
 MH Professional  Professional
 Psychiatrist  Advocate
 Physician
Mailing Address (street, city, state, zip)
Telephone (include area code) / County of Residence
Occupation
“X” One
 Partial Term  First  Second
Full Term Full Term / Year Term Expires
Board Name / Date Prepared
Board Member / Appointment Sex Minority
 ODMH  Male  African-American
 DADAS  Female  Hispanic
 County  Alaskan Native
 Asian or Pacific Islander
 Chairperson  Native American
 Other
Representation: “X” Only One
Mental Health Alcohol/Drug Addiction
 Consumer  Consumer
 Family Member  Family Member
 MH Professional  Professional
 Psychiatrist  Advocate
 Physician
Mailing Address (street, city, state, zip)
Telephone (include area code) / County of Residence
Occupation
“X” One
 Partial Term  First  Second
Full Term Full Term / Year Term Expires