Clontz, Eliza Diane

Clontz, Eliza Diane is an individual health care provider with primary practice located at 1019 Cumberland Falls Hwy Ste B201 , Corbin KY 40701. She recently has 2 registered licenses in different health care specialties including Behavioral Health & Social Service Providers / Addiction (Substance Use Disorder), Behavioral Health & Social Service Providers / Professional. Behavioral Health & Social Service Providers / Professional is her primary health care specialty. Clontz, Eliza Diane can be contacted via phone (606) 528-9005.

Contact Information

Primary practice address
1019 Cumberland Falls Hwy Ste B201 Corbin KY 40701
Phone: (606) 528-9005
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Addiction (Substance Use Disorder) 101YA0400X 165015 Kentucky
Behavioral Health & Social Service Providers / Professional 101YP2500X 105747 Kentucky

Profile Details

NPI number 1710105762
LBN Legal business name Clontz, Eliza Diane
Credentials LPCC LCADC SAP CSS
Entity Individual
Sole proprietor 1 No
Enumeration date Apr 23rd, 2007
Last updated Jan 31st, 2019 - about 6 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1710105762 NPPES
Kentucky MEDICAID 7100283130

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