Provider Demographics
NPI:1629391792
Name:MCCLOUD, IOLA CAROLYNE (LCSW)
Entity type:Individual
Prefix:MRS
First Name:IOLA
Middle Name:CAROLYNE
Last Name:MCCLOUD
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 1:711 HOUSTON ST
Mailing Address - Street 2:
Mailing Address - City:DOTHAN
Mailing Address - State:AL
Mailing Address - Zip Code:36303-6029
Mailing Address - Country:US
Mailing Address - Phone:334-671-8958
Mailing Address - Fax:334-479-8299
Practice Address - Street 1:2944 PENN AVE
Practice Address - Street 2:
Practice Address - City:MARIANNA
Practice Address - State:FL
Practice Address - Zip Code:32448-2741
Practice Address - Country:US
Practice Address - Phone:404-291-1585
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-03
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW0037101041C0700X
FLSW141251041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDVAD000OtherVAD000