Healthcare Provider Details

I. General information

NPI: 1164825691
Provider Name (Legal Business Name): ASHANTI MCLEOD MSSA,LSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/29/2014
Last Update Date: 09/29/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

592 E 101ST ST
CLEVELAND OH
44108-1373
US

IV. Provider business mailing address

592 E 101ST ST
CLEVELAND OH
44108-1373
US

V. Phone/Fax

Practice location:
  • Phone: 330-990-0644
  • Fax:
Mailing address:
  • Phone: 330-990-0644
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License NumberS1302922
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: