Individual
ELISHA A RUTH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCDCIII, QMHS
Contact information
Practice address
700 PARK AVE, IRONTON, OH 45638-1502
(740) 532-1613
(740) 879-0599
Mailing address
PO BOX 108, IRONTON, OH 45638-0108
(740) 532-1613
(740) 879-0599
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
LCDCIII.162402
OH
171M00000X
Case Manager/Care Coordinator
CDCA.172381
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0326903
—
OH
Enumeration date
07/31/2018
Last updated
09/22/2022
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