Individual
ETHAN THOMAS CRAIG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1199 DELAWARE AVE STE 107, 195 N GRANT AVE, COLUMBUS, OH 43215, MARION, OH 43302
(888) 522-9174
Mailing address
1865 BEALER DR APT G, MARION, OH 43302-8764
(740) 361-9098
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
S.1903694
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1003350448
—
OH
Enumeration date
12/04/2016
Last updated
05/31/2019
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