Healthcare Provider Details

I. General information

NPI: 1982123980
Provider Name (Legal Business Name): ELIZABETH WARD LCDCIII
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/12/2017
Last Update Date: 09/12/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111. NORTH HIGH STREET
WAVERLY OH
45690-9443
US

IV. Provider business mailing address

111 N HIGH ST
WAVERLY OH
45690-1343
US

V. Phone/Fax

Practice location:
  • Phone: 740-947-2364
  • Fax: 740-947-9379
Mailing address:
  • Phone: 740-947-2364
  • Fax: 740-947-9379

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberLCDCIII.161523
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: