Provider Demographics
NPI:1922600055
Name:KIM CLEVELAND THERAPY, LLC
Entity type:Organization
Organization Name:KIM CLEVELAND THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:KIM
Authorized Official - Last Name:CLEVELAND
Authorized Official - Suffix:
Authorized Official - Credentials:LPC,CAADC
Authorized Official - Phone:229-483-5050
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:229-483-1103
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-13
Last Update Date:2021-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty