Eastlick, Charles William

Eastlick, Charles William is an individual health care provider with primary practice located at 5108 Sandy Ln , Fairfield OH 45014-2738. He recently has 2 registered licenses in different health care specialties including Behavioral Health & Social Service Providers / Professional, Behavioral Health & Social Service Providers / Addiction (Substance Use Disorder). Behavioral Health & Social Service Providers / Addiction (Substance Use Disorder) is his primary health care specialty. Eastlick, Charles William can be contacted via phone (513) 834-7063.

Contact Information

Primary practice address
5108 Sandy Ln Fairfield OH 45014-2738
Phone: (513) 834-7063
Fax:
Website:
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Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Professional 101YP2500X C.0005142-SUPV Ohio
Behavioral Health & Social Service Providers / Addiction (Substance Use Disorder) 101YA0400X LICDC.001351 Ohio

Profile Details

NPI number 1982735189
LBN Legal business name Eastlick, Charles William
Credentials LICDC, LPC, M.ED.
Entity Individual
Sole proprietor 1 No
Enumeration date Mar 8th, 2007
Last updated Jul 22nd, 2019 - about 5 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 1982735189 NPPES
Ohio Other 310734113 TAX I.D.
Ohio MEDICAID MC0713 TAX I.D.

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