Provider Demographics
NPI:1851524300
Name:LEVINE, KENNETH MICHAEL (LCSW)
Entity Type:Individual
Prefix:MR
First Name:KENNETH
Middle Name:MICHAEL
Last Name:LEVINE
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 1:1502 W NC HIGHWAY 54
Mailing Address - Street 2:SUITE 505
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27707-5571
Mailing Address - Country:US
Mailing Address - Phone:919-475-3068
Mailing Address - Fax:
Practice Address - Street 1:1502 W NC HIGHWAY 54
Practice Address - Street 2:SUITE 505
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27707-5571
Practice Address - Country:US
Practice Address - Phone:919-475-3068
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-01
Last Update Date:2009-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0044091041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical