Provider Demographics
NPI:1568628634
Name:LEVITT, DIANA F (LPC)
Entity Type:Individual
Prefix:
First Name:DIANA
Middle Name:F
Last Name:LEVITT
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4525 HEDGEMORE DR
Mailing Address - Street 2:SUITE H
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28209-3235
Mailing Address - Country:US
Mailing Address - Phone:704-451-5534
Mailing Address - Fax:704-973-0806
Practice Address - Street 1:4525 HEDGEMORE DR
Practice Address - Street 2:SUITE H
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28209-3235
Practice Address - Country:US
Practice Address - Phone:704-451-5534
Practice Address - Fax:704-973-0806
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-29
Last Update Date:2014-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC7549101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6104689Medicaid