Healthcare Provider Details

I. General information

NPI: 1023514858
Provider Name (Legal Business Name): ISHANAE POLLARD MACJ, MSW, LSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/02/2018
Last Update Date: 04/02/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3740 EUCLID AVE
CLEVELAND OH
44115-2532
US

IV. Provider business mailing address

13301 ROCKSIDE RD
GARFIELD HTS OH
44125-5167
US

V. Phone/Fax

Practice location:
  • Phone: 216-361-9870
  • Fax:
Mailing address:
  • Phone: 216-832-1547
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: