Provider Demographics
NPI:1851021844
Name:LEVITATE
Entity Type:Organization
Organization Name:LEVITATE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/LPCC
Authorized Official - Prefix:MS
Authorized Official - First Name:LAQUISHA
Authorized Official - Middle Name:
Authorized Official - Last Name:MOORE
Authorized Official - Suffix:
Authorized Official - Credentials:MED
Authorized Official - Phone:502-315-9969
Mailing Address - Street 1:2900 W BROADWAY STE 16
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40211-1294
Mailing Address - Country:US
Mailing Address - Phone:502-315-9969
Mailing Address - Fax:
Practice Address - Street 1:2900 W BROADWAY STE 16
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40211-1294
Practice Address - Country:US
Practice Address - Phone:502-315-9969
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-14
Last Update Date:2022-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty