Provider Demographics
NPI:1912092198
Name:CLEVELAND, GALE OTELLO (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:GALE
Middle Name:OTELLO
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 1:12644 CHAPEL RD.
Mailing Address - Street 2:SUITE 112
Mailing Address - City:CLIFTON
Mailing Address - State:VA
Mailing Address - Zip Code:20124
Mailing Address - Country:US
Mailing Address - Phone:703-803-3294
Mailing Address - Fax:703-803-0164
Practice Address - Street 1:12644 CHAPEL RD
Practice Address - Street 2:SUITE 112
Practice Address - City:CLIFTON
Practice Address - State:VA
Practice Address - Zip Code:20124-1706
Practice Address - Country:US
Practice Address - Phone:703-803-3294
Practice Address - Fax:703-803-0164
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA1345101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health