Provider Demographics
NPI:1881265270
Name:LEVINGSTON, JAVAR
Entity type:Individual
Prefix:
First Name:JAVAR
Middle Name:
Last Name:LEVINGSTON
Suffix:
Gender:X
Credentials:
Other - Prefix:
Other - First Name:ANAFIEL
Other - Middle Name:
Other - Last Name:SOLUNA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1952 SE 122ND AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97233-1304
Mailing Address - Country:US
Mailing Address - Phone:503-597-3908
Mailing Address - Fax:
Practice Address - Street 1:1952 SE 122ND AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97233-1304
Practice Address - Country:US
Practice Address - Phone:503-597-3908
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-07
Last Update Date:2024-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician