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Individual

MISS GINA MAUREEN CLEVELAND

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
LVN, LPN

Contact information

Practice address
417 BALLYMORE PASS, WOODSTOCK, GA 30189-7418
(559) 760-8641
Mailing address
417 BALLYMORE PASS, WOODSTOCK, GA 30189-7418
(559) 760-8641

Taxonomy

Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
164W00000X
Licensed Practical Nurse
Primary
LPN090192
GA
164X00000X
Licensed Vocational Nurse
VN237459
CA

Other

Enumeration date
06/17/2009
Last updated
07/21/2022
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