Provider Demographics
NPI:1740051200
Name:CLEVELAND, DESTINIE (MS, CPC-I, CADC-I)
Entity type:Individual
Prefix:
First Name:DESTINIE
Middle Name:
Last Name:CLEVELAND
Suffix:
Gender:F
Credentials:MS, CPC-I, CADC-I
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:310 S MARYLAND PKWY APT 10
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89101-5357
Mailing Address - Country:US
Mailing Address - Phone:602-643-8329
Mailing Address - Fax:
Practice Address - Street 1:2620 REGATTA DR STE 210
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89128-6891
Practice Address - Country:US
Practice Address - Phone:725-333-2643
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-12
Last Update Date:2024-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV07533-I101YA0400X
NVCI5448101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)