Provider Demographics
NPI:1164825691
Name:MCLEOD, ASHANTI (MSSA,LSW)
Entity Type:Individual
Prefix:
First Name:ASHANTI
Middle Name:
Last Name:MCLEOD
Suffix:
Gender:F
Credentials:MSSA,LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:592 E 101ST ST
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44108-1373
Mailing Address - Country:US
Mailing Address - Phone:330-990-0644
Mailing Address - Fax:
Practice Address - Street 1:592 E 101ST ST
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44108-1373
Practice Address - Country:US
Practice Address - Phone:330-990-0644
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-29
Last Update Date:2014-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS1302922101YS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool