Provider Demographics
NPI:1003433293
Name:LEVITINE-WOODSIDE, ANNETTE MARGUERITE (LCPC, LPC)
Entity Type:Individual
Prefix:
First Name:ANNETTE
Middle Name:MARGUERITE
Last Name:LEVITINE-WOODSIDE
Suffix:
Gender:F
Credentials:LCPC, LPC
Other - Prefix:MS
Other - First Name:ANNETTE
Other - Middle Name:M
Other - Last Name:LEVITINE-WOODSIDE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:8214 STONE TRAIL DR
Mailing Address - Street 2:
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20817-4556
Mailing Address - Country:US
Mailing Address - Phone:301-509-1663
Mailing Address - Fax:
Practice Address - Street 1:8214 STONE TRAIL DR
Practice Address - Street 2:
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20817-4556
Practice Address - Country:US
Practice Address - Phone:301-509-1663
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-03
Last Update Date:2020-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC5930101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDLC5930OtherMARYLAND SOLE PROVIDER