Provider Demographics
NPI:1407822885
Name:LEVINE, ONEIDA H
Entity Type:Individual
Prefix:
First Name:ONEIDA
Middle Name:H
Last Name:LEVINE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ONEIDA
Other - Middle Name:H
Other - Last Name:LEVINE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:1710 COUNTRY CLUB RD
Mailing Address - Street 2:
Mailing Address - City:MOREHEAD CITY
Mailing Address - State:NC
Mailing Address - Zip Code:28557-4838
Mailing Address - Country:US
Mailing Address - Phone:919-738-4649
Mailing Address - Fax:252-726-8403
Practice Address - Street 1:1710 COUNTRY CLUB RD
Practice Address - Street 2:
Practice Address - City:MOREHEAD CITY
Practice Address - State:NC
Practice Address - Zip Code:28557-4838
Practice Address - Country:US
Practice Address - Phone:919-738-4649
Practice Address - Fax:252-726-8403
Is Sole Proprietor?:No
Enumeration Date:2006-02-27
Last Update Date:2008-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2489103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6000418Medicaid
NC60000418Medicaid
NC0428YOtherBCBS INDIVIDUAL