Provider Demographics
NPI:1053069336
Name:CLEATON, JAMES
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:
Last Name:CLEATON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 WALKER AVE STE 304
Mailing Address - Street 2:
Mailing Address - City:PIKESVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21208-4067
Mailing Address - Country:US
Mailing Address - Phone:443-213-8243
Mailing Address - Fax:
Practice Address - Street 1:19 WALKER AVE STE 304
Practice Address - Street 2:
Practice Address - City:PIKESVILLE
Practice Address - State:MD
Practice Address - Zip Code:21208-4067
Practice Address - Country:US
Practice Address - Phone:443-213-8243
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-15
Last Update Date:2022-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDNONEMedicaid