Provider Demographics
NPI:1083967145
Name:LEVY, ANTHONIA (PHD, LMHC, LPC)
Entity Type:Individual
Prefix:
First Name:ANTHONIA
Middle Name:
Last Name:LEVY
Suffix:
Gender:F
Credentials:PHD, LMHC, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:157 HAMPTON POINT DR STE 1
Mailing Address - Street 2:
Mailing Address - City:ST AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32092-3054
Mailing Address - Country:US
Mailing Address - Phone:904-415-3755
Mailing Address - Fax:
Practice Address - Street 1:157 HAMPTON POINT DR STE 1
Practice Address - Street 2:
Practice Address - City:ST AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32092-3054
Practice Address - Country:US
Practice Address - Phone:904-415-3755
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-25
Last Update Date:2017-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701006395101Y00000X
MDLC4739101Y00000X
FLMH15316101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor