Provider Demographics
NPI:1801392022
Name:PITTS-CLAY, CAROLYN DIANE (BSW, CDCA, OCPSA)
Entity Type:Individual
Prefix:MRS
First Name:CAROLYN
Middle Name:DIANE
Last Name:PITTS-CLAY
Suffix:
Gender:F
Credentials:BSW, CDCA, OCPSA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4100 FRANKLIN BLVD
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44113-2842
Mailing Address - Country:US
Mailing Address - Phone:216-658-4640
Mailing Address - Fax:216-281-2506
Practice Address - Street 1:4100 FRANKLIN BLVD
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44113-2842
Practice Address - Country:US
Practice Address - Phone:216-281-2500
Practice Address - Fax:216-281-2506
Is Sole Proprietor?:No
Enumeration Date:2018-04-05
Last Update Date:2018-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHBSW390200000X
OHOCPSA.161399405300000X
OHCDCA.100054101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No405300000XOther Service ProvidersPrevention Professional