Healthcare Provider Details

I. General information

NPI: 1093267486
Provider Name (Legal Business Name): JOHN EDWARD ENTINGH SR. LSW, LICDC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/01/2016
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

551 1/2 E MAIN ST
LANCASTER OH
43130-3809
US

IV. Provider business mailing address

PO BOX 243
SUGAR GROVE OH
43155-0243
US

V. Phone/Fax

Practice location:
  • Phone: 614-404-6008
  • Fax:
Mailing address:
  • Phone: 614-404-6008
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number141191
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberS.1501042
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: