Provider Demographics
NPI:1386073765
Name:MCCLOUD, ALFRED JAMES (LCSW)
Entity type:Individual
Prefix:
First Name:ALFRED
Middle Name:JAMES
Last Name:MCCLOUD
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1465 E 103RD ST
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90002-3306
Mailing Address - Country:US
Mailing Address - Phone:310-720-1548
Mailing Address - Fax:
Practice Address - Street 1:1465 E 103RD ST
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90002-3306
Practice Address - Country:US
Practice Address - Phone:323-564-7911
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-05
Last Update Date:2022-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1041551041C0700X
CAASW33376104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical