Kim Cleveland Therapy, LLC

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

Legal business name

KIM CLEVELAND THERAPY, LLC

Practice address

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

Phone

(229) 483-5050

Fax

(229) 485-1103

NPI assigned

Nov 13, 2020

Organization subpart

No

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

Authorized official

Name

Lisa Kim Cleveland, LPC,CAADC

Title

Owner

Phone

(229) 483-5050

Specialties & licenses 2

Addresses

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

{
    "created_epoch": "1605225600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1612396800000",
    "number": "1922600055",
    "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": "229-483-1103"
        },
        {
            "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": {
        "organization_name": "KIM CLEVELAND THERAPY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-11-13",
        "last_updated": "2021-02-04",
        "certification_date": "2021-02-04",
        "status": "A",
        "authorized_official_last_name": "CLEVELAND",
        "authorized_official_first_name": "LISA",
        "authorized_official_middle_name": "KIM",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "229-483-5050",
        "authorized_official_credential": "LPC,CAADC"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Counselor, Professional",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.