Active NPI
Charles William Eastlick, LICDC, LPC, M.ED.
- Addiction (Substance Use Disorder) Counselor
- Fairfield, OH
National Provider Identifier
1982735189
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Addiction (Substance Use Disorder) Counselor
- License
- LICDC.001351
- Practice address
- 5108 Sandy LN
Fairfield, OH 45014-2738 - Phone
- (513) 834-7063
- NPI assigned
- Mar 8, 2007
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | C.0005142-SUPV | OH | |
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | LICDC.001351 | OH | Primary |
Addresses
Primary practice location
5108 Sandy LN
Fairfield, OH 45014-2738
Mailing address
446 Morgan St
Cincinnati, OH 45206-2348
Phone (513) 834-7063
Other practice location 1
1659 S Breiel Blvd
Middletown, OH 45044-6705
Phone (513) 424-0921 ext. 14
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 310734113 | Other | OH | TAX I.D. |
| MC0713 | Medicaid | OH |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Master of Education
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| LICDC.001351 | OH | MD | Addiction (Substance Use Disorder) Counselor |
| C.0005142-SUPV | OH | MD | Professional Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1173312000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1563753600000",
"number": "1982735189",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "446 MORGAN ST",
"city": "CINCINNATI",
"state": "OH",
"postal_code": "452062348",
"telephone_number": "513-834-7063",
"fax_number": "513-873-1567"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5108 SANDY LN",
"city": "FAIRFIELD",
"state": "OH",
"postal_code": "450142738",
"telephone_number": "513-834-7063"
}
],
"practiceLocations": [
{
"address_1": "1659 S Breiel Blvd",
"address_purpose": "LOCATION",
"city": "Middletown",
"state": "OH",
"postal_code": "450446705",
"country_code": "US",
"telephone_number": "513-424-0921 x14",
"fax_number": "513-424-4810",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "EASTLICK",
"first_name": "CHARLES",
"middle_name": "WILLIAM",
"name_prefix": "Mr.",
"credential": "LICDC, LPC, M.ED.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-03-08",
"last_updated": "2019-07-22",
"status": "A"
},
"taxonomies": [
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "OH",
"license": "C.0005142-SUPV",
"primary": false
},
{
"code": "101YA0400X",
"taxonomy_group": "",
"desc": "Counselor, Addiction (Substance Use Disorder)",
"state": "OH",
"license": "LICDC.001351",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "TAX I.D.",
"identifier": "310734113",
"state": "OH"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "MC0713",
"state": "OH"
}
],
"endpoints": [],
"other_names": []
}Other providers in Fairfield, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 22, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.