Provider Demographics
NPI:1629510789
Name:LEVINE, KATE MERCEDES (LLP)
Entity Type:Individual
Prefix:
First Name:KATE
Middle Name:MERCEDES
Last Name:LEVINE
Suffix:
Gender:F
Credentials:LLP
Other - Prefix:
Other - First Name:MERCEDES
Other - Middle Name:
Other - Last Name:KOLESNIKOVA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LLP
Mailing Address - Street 1:3820 PACKARD ST STE 250
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48108-5017
Mailing Address - Country:US
Mailing Address - Phone:734-780-7338
Mailing Address - Fax:
Practice Address - Street 1:3820 PACKARD ST STE 250
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48108-5017
Practice Address - Country:US
Practice Address - Phone:734-780-7338
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-11-07
Last Update Date:2023-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6361001566103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical