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General NPI Number Information
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NPI Number | 1093267486
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Entity Type | Individual
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Provider Name | JOHN EDWARD ENTINGH SR. LSW, LICDC
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Gender | Male
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Dates
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Enumeration Date | 11/01/2016
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 551 1/2 E MAIN ST
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City | LANCASTER
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State | OH
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Zip | 43130-3809
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Country | US
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Telephone | 614-404-6008
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 243
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City | SUGAR GROVE
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State | OH
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Zip | 43155-0243
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Country | US
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Telephone | 614-404-6008
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 141191
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | S.1501042
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License Number State | OH
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