Provider Demographics
NPI:1073005823
Name:EBLIN, MICHAEL LEE ALLEN (LSW)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:LEE ALLEN
Last Name:EBLIN
Suffix:
Gender:M
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3645 RIDGE MILL DR
Mailing Address - Street 2:
Mailing Address - City:HILLIARD
Mailing Address - State:OH
Mailing Address - Zip Code:43026-7752
Mailing Address - Country:US
Mailing Address - Phone:614-457-7876
Mailing Address - Fax:614-457-7896
Practice Address - Street 1:3645 RIDGE MILL DR
Practice Address - Street 2:
Practice Address - City:HILLIARD
Practice Address - State:OH
Practice Address - Zip Code:43026-7752
Practice Address - Country:US
Practice Address - Phone:614-457-7876
Practice Address - Fax:614-457-7896
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-06
Last Update Date:2018-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS.18024881041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical