Provider Demographics
NPI:1811325137
Name:CLEVENGER, ADAM M (LPCC-S, CST, CSTS)
Entity type:Individual
Prefix:
First Name:ADAM
Middle Name:M
Last Name:CLEVENGER
Suffix:
Gender:M
Credentials:LPCC-S, CST, CSTS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2939 KENNY RD STE 195
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43221-2406
Mailing Address - Country:US
Mailing Address - Phone:614-957-0164
Mailing Address - Fax:
Practice Address - Street 1:2939 KENNY RD STE 195
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43221-2406
Practice Address - Country:US
Practice Address - Phone:614-957-0164
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-10-23
Last Update Date:2024-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180.010570101YP2500X
OHE.1901569101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional