=====================================================
General NPI Number Information
=====================================================
NPI Number | 1750262333
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ALVIN MCCOY CHW
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/10/2025
-----------------------------------------------------
Last Update Date | 09/10/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1530 SAINT CLAIR AVE NE
-----------------------------------------------------
City | CLEVELAND
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44114-2004
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 216-535-9100
-----------------------------------------------------
Fax | 216-298-5015
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 9009 JEFFRIES AVE
-----------------------------------------------------
City | CLEVELAND
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44105-6067
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 216-970-6100
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101Y00000X
-----------------------------------------------------
Taxonomy Name | Counselor
-----------------------------------------------------
License Number | CHW00297
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------