Individual
ERIC CLINTON WALLACE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
247 CIC BLVD, WEST UNION, OH 45693-7512
(513) 941-4999
(513) 694-0168
Mailing address
6460 HARRISON AVE STE 200, CINCINNATI, OH 45247-7958
(513) 941-4999
(513) 694-0168
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
CDCA.164839
OH
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
CDCA.168404
OH
101YM0800X
Mental Health Counselor
QMHS
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0273638
—
OH
Enumeration date
11/09/2017
Last updated
05/26/2023
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