Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YA0400X | Addiction Counselor (Substance Use Disorder) | LICDC.162047 | OH |
Y | 1041C0700X | Clinical Social Worker | I.1800951-SUPV | OH |
NPI | 1003249277 |
---|---|
Provider Name | Elizabeth R Chalfant |
First Address | Newark, OH 43055-9233 |
Second Address | Newark, OH 43055-9233 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/08/2013 |
Last Update Date | 19/08/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0200008 | (05) | OH |