Individual
ETHAN G PRESTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LCDC III, QMHS
Contact information
Practice address
700 PARK AVE, IRONTON, OH 45638-1502
(740) 532-1613
Mailing address
PO BOX 108, IRONTON, OH 45638-0108
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
LCDCIII.162777
OH
171M00000X
Case Manager/Care Coordinator
CDCA.175127
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0358491
—
OH
Enumeration date
07/11/2019
Last updated
01/24/2025
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