Individual
MR. CHARLES WILLIAM EASTLICK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LICDC, LPC, M.ED.
Contact information
Practice address
5108 SANDY LN, FAIRFIELD, OH 45014-2738
(513) 834-7063
Mailing address
446 MORGAN ST, CINCINNATI, OH 45206-2348
(513) 834-7063
(513) 873-1567
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
LICDC.001351
OH
101YP2500X
Professional Counselor
C.0005142-SUPV
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
310734113
TAX I.D.
OH
05
—
MC0713
—
OH
Enumeration date
03/08/2007
Last updated
07/22/2019
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