Provider Demographics
NPI:1184904211
Name:CLEVELAND, IRIS BRANCH (LCSW)
Entity type:Individual
Prefix:MS
First Name:IRIS
Middle Name:BRANCH
Last Name:CLEVELAND
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:715 BRADLEY DR
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30214-2030
Mailing Address - Country:US
Mailing Address - Phone:770-638-5252
Mailing Address - Fax:770-460-2463
Practice Address - Street 1:715 BRADLEY DR
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30214-2030
Practice Address - Country:US
Practice Address - Phone:770-638-5252
Practice Address - Fax:770-460-2463
Is Sole Proprietor?:No
Enumeration Date:2011-08-21
Last Update Date:2011-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0019001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical