Healthcare Provider Details

I. General information

NPI: 1902360886
Provider Name (Legal Business Name): EMILY LEVENTIS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: EMILY WILCOX

II. Dates (important events)

Enumeration Date: 01/25/2019
Last Update Date: 06/24/2025
Certification Date: 06/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27928 HOPKINS DR
NOVI MI
48377-2564
US

IV. Provider business mailing address

27928 HOPKINS DR
NOVI MI
48377-2564
US

V. Phone/Fax

Practice location:
  • Phone: 248-961-0760
  • Fax:
Mailing address:
  • Phone: 248-277-3005
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number7401000626
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: