Provider Demographics
NPI:1902461098
Name:CLEVELAND, LISA KIM (LPC,CAADC, NCC)
Entity Type:Individual
Prefix:MRS
First Name:LISA
Middle Name:KIM
Last Name:CLEVELAND
Suffix:
Gender:F
Credentials:LPC,CAADC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1511 W 3RD AVE STE 104
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:GA
Mailing Address - Zip Code:31707-3658
Mailing Address - Country:US
Mailing Address - Phone:229-483-5050
Mailing Address - Fax:229-485-1103
Practice Address - Street 1:1511 W 3RD AVE STE 104
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:GA
Practice Address - Zip Code:31707-3658
Practice Address - Country:US
Practice Address - Phone:229-483-5050
Practice Address - Fax:229-485-1103
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-05
Last Update Date:2021-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA005668101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty