Individual
MARK A STURDIVANT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
2121 W 117TH ST, CLEVELAND, OH 44111-1642
(216) 417-4831
Mailing address
2121 W 117TH ST, CLEVELAND, OH 44111-1642
(216) 417-4831
Taxonomy
Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
Primary
0002834
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0002834
PEER SUPPORT CERTIFICATION
OH
Enumeration date
11/11/2021
Last updated
11/11/2021
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