Provider Demographics
NPI:1821212077
Name:LEVINKSY-WOHL, MINA (LCMHC)
Entity type:Individual
Prefix:
First Name:MINA
Middle Name:
Last Name:LEVINKSY-WOHL
Suffix:
Gender:F
Credentials:LCMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:166 BATTERY ST
Mailing Address - Street 2:SUITE 4
Mailing Address - City:BURLINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05401-5283
Mailing Address - Country:US
Mailing Address - Phone:802-863-8137
Mailing Address - Fax:802-863-8137
Practice Address - Street 1:166 BATTERY ST
Practice Address - Street 2:SUITE 4
Practice Address - City:BURLINGTON
Practice Address - State:VT
Practice Address - Zip Code:05401-5283
Practice Address - Country:US
Practice Address - Phone:802-863-8137
Practice Address - Fax:802-863-8137
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT0680000403101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1007152Medicaid