Provider Demographics
NPI:1205242740
Name:MCLEOD, COLETTE SHANDRIA (MA)
Entity type:Individual
Prefix:
First Name:COLETTE
Middle Name:SHANDRIA
Last Name:MCLEOD
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2200 LAKEVIEW RIDGE CIR APT 103
Mailing Address - Street 2:
Mailing Address - City:APOPKA
Mailing Address - State:FL
Mailing Address - Zip Code:32703-9276
Mailing Address - Country:US
Mailing Address - Phone:352-205-1578
Mailing Address - Fax:
Practice Address - Street 1:2101 LAKEVIEW RIDGE CIR
Practice Address - Street 2:
Practice Address - City:APOPKA
Practice Address - State:FL
Practice Address - Zip Code:32703-9332
Practice Address - Country:US
Practice Address - Phone:352-205-1578
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-04
Last Update Date:2023-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH14616101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty