Provider Demographics
NPI:1992387344
Name:CLEVELAND, KANCY (LPC)
Entity Type:Individual
Prefix:
First Name:KANCY
Middle Name:
Last Name:CLEVELAND
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:340 E MAIN ST STE 102
Mailing Address - Street 2:
Mailing Address - City:SPARTANBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29302-1987
Mailing Address - Country:US
Mailing Address - Phone:864-707-2167
Mailing Address - Fax:864-707-2168
Practice Address - Street 1:340 E MAIN ST STE 102
Practice Address - Street 2:
Practice Address - City:SPARTANBURG
Practice Address - State:SC
Practice Address - Zip Code:29302-1987
Practice Address - Country:US
Practice Address - Phone:864-707-2167
Practice Address - Fax:864-707-2168
Is Sole Proprietor?:No
Enumeration Date:2021-04-26
Last Update Date:2021-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC4029101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional