Provider Demographics
NPI:1164759494
Name:LEVITT, BERT LOUIS (LPC)
Entity Type:Individual
Prefix:MR
First Name:BERT
Middle Name:LOUIS
Last Name:LEVITT
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:630 RIDGEWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30501-3138
Mailing Address - Country:US
Mailing Address - Phone:770-532-7775
Mailing Address - Fax:
Practice Address - Street 1:630 RIDGEWOOD AVE
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:GA
Practice Address - Zip Code:30501-3138
Practice Address - Country:US
Practice Address - Phone:770-532-7775
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-06
Last Update Date:2009-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC000756101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor