Provider Demographics
NPI:1083109003
Name:LIVINGSTON, DELORES (LPC, LSW)
Entity Type:Individual
Prefix:
First Name:DELORES
Middle Name:
Last Name:LIVINGSTON
Suffix:
Gender:F
Credentials:LPC, LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2561
Mailing Address - Street 2:
Mailing Address - City:WINTERSVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43953-0561
Mailing Address - Country:US
Mailing Address - Phone:740-381-6758
Mailing Address - Fax:740-381-6052
Practice Address - Street 1:501 WASHINGTON ST STE 205
Practice Address - Street 2:
Practice Address - City:STEUBENVILLE
Practice Address - State:OH
Practice Address - Zip Code:43952-2185
Practice Address - Country:US
Practice Address - Phone:740-381-6758
Practice Address - Fax:740-381-6052
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-22
Last Update Date:2019-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH101YP2500X
OHC1400074101YP2500X
OHS7605104100000X
OHE.1901417101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
No104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty