Provider Demographics
NPI:1699404020
Name:LEVI, LORETTA JEAN (LPC)
Entity Type:Individual
Prefix:
First Name:LORETTA
Middle Name:JEAN
Last Name:LEVI
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 1:5072 WELLS DR
Mailing Address - Street 2:
Mailing Address - City:EVANS
Mailing Address - State:GA
Mailing Address - Zip Code:30809-7036
Mailing Address - Country:US
Mailing Address - Phone:410-725-0138
Mailing Address - Fax:
Practice Address - Street 1:4145 COLUMBIA RD
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30907-5400
Practice Address - Country:US
Practice Address - Phone:706-869-7373
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-09
Last Update Date:2022-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC010571101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional