Healthcare Provider Details

I. General information

NPI: 1811404502
Provider Name (Legal Business Name): FELICIA LEE LSW, LCDCIII
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/04/2018
Last Update Date: 01/04/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1905 E 89TH ST
CLEVELAND OH
44106-2007
US

IV. Provider business mailing address

6522 ROGERS AVE
CLEVELAND OH
44127-1438
US

V. Phone/Fax

Practice location:
  • Phone: 216-231-3772
  • Fax: 216-237-2881
Mailing address:
  • Phone: 216-502-7772
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number161591
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number1701620
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: