Provider Demographics
NPI:1447996350
Name:MOTLEY, COUNTEE GHAI JR
Entity type:Individual
Prefix:MR
First Name:COUNTEE
Middle Name:GHAI
Last Name:MOTLEY
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6216 STORER AVE
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44102-5526
Mailing Address - Country:US
Mailing Address - Phone:440-985-0787
Mailing Address - Fax:
Practice Address - Street 1:6216 STORER AVE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44102-5526
Practice Address - Country:US
Practice Address - Phone:440-985-0787
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-12
Last Update Date:2022-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TA0700XBehavioral Health & Social Service ProvidersPsychologistAdult Development & Aging
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH00Medicaid