Wallace, Eric Clinton

Wallace, Eric Clinton is an sole proprietor health care provider with primary practice located at 247 Cic Blvd , West Union OH 45693-7512. He recently has 2 registered licenses in different health care specialties including Behavioral Health & Social Service Providers / Addiction (Substance Use Disorder), Behavioral Health & Social Service Providers / Mental Health. Behavioral Health & Social Service Providers / Addiction (Substance Use Disorder) is his primary health care specialty. Wallace, Eric Clinton can be contacted via phone (513) 941-4999.

Contact Information

Primary practice address
247 Cic Blvd West Union OH 45693-7512
Phone: (513) 941-4999
Fax: (513) 694-0168
Website:
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Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Addiction (Substance Use Disorder) 101YA0400X CDCA.164839 Ohio
Behavioral Health & Social Service Providers / Mental Health 101YM0800X QMHS Ohio
Behavioral Health & Social Service Providers / Addiction (Substance Use Disorder) 101YA0400X CDCA.168404 Ohio

Profile Details

NPI number 1366955585
LBN Legal business name Wallace, Eric Clinton
Credentials
Entity Individual
Sole proprietor 1 Yes
Enumeration date Nov 9th, 2017
Last updated May 26th, 2023 - about 3 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1366955585 NPPES
Ohio MEDICAID 0273638

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