Provider Demographics
NPI:1386819050
Name:LEVINE, TERRANCE ALFRED (LPC, CCSOTS)
Entity Type:Individual
Prefix:MR
First Name:TERRANCE
Middle Name:ALFRED
Last Name:LEVINE
Suffix:
Gender:M
Credentials:LPC, CCSOTS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 E MAIN ST STE 1600-168
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23510-2205
Mailing Address - Country:US
Mailing Address - Phone:757-418-0348
Mailing Address - Fax:
Practice Address - Street 1:2444 COMMERCE RD
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28546-7560
Practice Address - Country:US
Practice Address - Phone:910-650-2227
Practice Address - Fax:910-346-2393
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-24
Last Update Date:2022-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC6981101YP2500X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6103910Medicaid
NC495133OtherTRICARE