Provider Demographics
NPI:1235463738
Name:LEVESQUE, COLIN DANIEL (BA, BCABA)
Entity Type:Individual
Prefix:
First Name:COLIN
Middle Name:DANIEL
Last Name:LEVESQUE
Suffix:
Gender:M
Credentials:BA, BCABA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1801 DON QUIXOTE CIR
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32250-2036
Mailing Address - Country:US
Mailing Address - Phone:321-960-7925
Mailing Address - Fax:904-538-0714
Practice Address - Street 1:10175 FORTUNE PKWY UNIT 903
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32256-6755
Practice Address - Country:US
Practice Address - Phone:904-538-0713
Practice Address - Fax:904-538-0714
Is Sole Proprietor?:No
Enumeration Date:2009-09-30
Last Update Date:2009-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL0-08-2432103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst