Doctor Name: | MR. JEFFRY D LEVESQUE |
NPI Number: | 1023484516 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | MSW, LICSW |
License Number: | 02517 |
Business Practice Address: | 510 S Seminary St Charles Town, WV - 254141347 |
Business Phone Number: | 3042407040 |
Business Fax Number: | |
Mailing Address: | 510 S. Seminary St., CHARLES TOWN |
State: | WV |
Postal Code: | 254141347 |
Phone Number: | 3042407040 |
Fax Number: | |
NPI Enumeration Date: | 08/19/2015 |
NPI Last Update Date: | 08/19/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YM0800X |
License Number: | 02517 |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | MD |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Mental Health |
Taxonomy Definition: |