Lisa Kim Cleveland, LPC,CAADC, NCC

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

005668 Issued in GA

Practice address

1511 W 3Rd Ave Ste 104
Albany, GA 31707-3658

Phone

(229) 483-5050

Fax

(229) 485-1103

NPI assigned

May 5, 2019

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Opted out of Medicare

Yes, effective Jan 9, 2024 through Jan 9, 2028

Medicare enrollment (NPD)

Not enrolled

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Kim Cleveland Therapy, LLC

  • Professional Counselor
  • Albany, GA
  • NPI 1922600055
  Authorized official Same address or phone

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1557014400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1612396800000",
    "number": "1902461098",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1511 W 3RD AVE STE 104",
            "city": "ALBANY",
            "state": "GA",
            "postal_code": "317073658",
            "telephone_number": "229-483-5050",
            "fax_number": "229-485-1103"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1511 W 3RD AVE STE 104",
            "city": "ALBANY",
            "state": "GA",
            "postal_code": "317073658",
            "telephone_number": "229-483-5050",
            "fax_number": "229-485-1103"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLEVELAND",
        "first_name": "LISA",
        "middle_name": "KIM",
        "name_prefix": "Mrs.",
        "credential": "LPC,CAADC, NCC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2019-05-05",
        "last_updated": "2021-02-04",
        "certification_date": "2021-02-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "GA",
            "license": "005668",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Tiara H Clayton
• Elizabeth Ann Clement, DC
• Alshica Harper Clements
• Gina Barbee Clenney, PT
• Christopher Seth Cleveland
• Joe Walter Clift, MFT
• Jacob Cline, DMD
• Sarah Lynn Codrea, D.O.
• Mark D Cohen, M.D.
• Charles R Cole, NP

• Professional Counselor in Albany, GA
• Providers in Albany, GA by specialty
• Professional Counselor in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 4, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.