Provider Demographics
NPI:1497082994
Name:LEAVITT, CAROLINE HECHT (PHD)
Entity Type:Individual
Prefix:DR
First Name:CAROLINE
Middle Name:HECHT
Last Name:LEAVITT
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 W WIEUCA RD NE
Mailing Address - Street 2:SUITE 314
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30342-3352
Mailing Address - Country:US
Mailing Address - Phone:678-637-5864
Mailing Address - Fax:
Practice Address - Street 1:300 W WIEUCA RD NE
Practice Address - Street 2:SUITE 314
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30342-3352
Practice Address - Country:US
Practice Address - Phone:678-637-5864
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-04
Last Update Date:2009-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPSY003317103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist