Provider Demographics
NPI:1225727589
Name:VANCLEAVE, AMY ELIZABETH
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:ELIZABETH
Last Name:VANCLEAVE
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 1:1815 W MARKET ST
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44313-7000
Mailing Address - Country:US
Mailing Address - Phone:855-747-4673
Mailing Address - Fax:
Practice Address - Street 1:1815 W MARKET ST
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44313-7000
Practice Address - Country:US
Practice Address - Phone:855-747-4673
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-03
Last Update Date:2024-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCDCA.187675101YA0400X
OHAPS.004047175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)