Individual
MR. CHARLES EARL ETHERIDGE JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CDCA
Contact information
Practice address
1131 E BROAD ST, ELYRIA, OH 44035-6305
(440) 365-1900
Mailing address
1131 E BROAD ST, ELYRIA, OH 44035-6305
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
CDCA.164758
OH
Other
Enumeration date
09/15/2017
Last updated
09/15/2017
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