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General NPI Number Information
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NPI Number | 1912092198
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Entity Type | Individual
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Provider Name | GALE OTELLO CLEVELAND L.C.S.W.
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Gender | Female
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Dates
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Enumeration Date | 10/04/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 12644 CHAPEL RD SUITE 112
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City | CLIFTON
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State | VA
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Zip | 20124-1706
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Country | US
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Telephone | 703-803-3294
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Fax | 703-803-0164
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Provider Business Mailing Address
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Address Line | 12644 CHAPEL RD. SUITE 112
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City | CLIFTON
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State | VA
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Zip | 20124
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Country | US
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Telephone | 703-803-3294
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Fax | 703-803-0164
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 1345
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License Number State | VA
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