Provider Demographics
NPI:1124576608
Name:CLEVELAND, CLARISSA
Entity type:Individual
Prefix:
First Name:CLARISSA
Middle Name:
Last Name:CLEVELAND
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:06 REDSTONE STREET
Mailing Address - Street 2:
Mailing Address - City:AMBLER
Mailing Address - State:AK
Mailing Address - Zip Code:99786
Mailing Address - Country:US
Mailing Address - Phone:907-445-2192
Mailing Address - Fax:
Practice Address - Street 1:110 AIRPORT STREET
Practice Address - Street 2:
Practice Address - City:AMBLER
Practice Address - State:AK
Practice Address - Zip Code:99786
Practice Address - Country:US
Practice Address - Phone:907-445-2129
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-14
Last Update Date:2016-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)