Provider Demographics
NPI:1780679027
Name:LEVERTY, ALEXANDER TAYLOR (LCSW)
Entity Type:Individual
Prefix:MR
First Name:ALEXANDER
Middle Name:TAYLOR
Last Name:LEVERTY
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9020 STONY POINT PKWY
Mailing Address - Street 2:STE 240
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23235
Mailing Address - Country:US
Mailing Address - Phone:804-282-5236
Mailing Address - Fax:804-282-5547
Practice Address - Street 1:9020 STONY POINT PKWY
Practice Address - Street 2:STE 240
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23235
Practice Address - Country:US
Practice Address - Phone:804-282-5236
Practice Address - Fax:804-282-5547
Is Sole Proprietor?:No
Enumeration Date:2005-09-13
Last Update Date:2013-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040045471041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA306836OtherBC/BS
089781OtherSENTARA
VA1780679027Medicaid
VA507248OtherVALUE OPTION
089781OtherSENTARA
VA507248OtherVALUE OPTION