Provider Demographics
NPI:1558591446
Name:LEVACK, DEBRA A (LCSW)
Entity Type:Individual
Prefix:
First Name:DEBRA
Middle Name:A
Last Name:LEVACK
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3014 ESCAPARDO CIR
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80917-3343
Mailing Address - Country:US
Mailing Address - Phone:719-310-0254
Mailing Address - Fax:
Practice Address - Street 1:1248 PIROS DR
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80922-1135
Practice Address - Country:US
Practice Address - Phone:719-573-7837
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-26
Last Update Date:2016-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO9926531041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical