Healthcare Provider Details

I. General information

NPI: 1871225581
Provider Name (Legal Business Name): JAYKI RO LEVY LCMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2022
Last Update Date: 06/05/2026
Certification Date: 06/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11 WHISTLE RDG
CANDLER NC
28715-9347
US

IV. Provider business mailing address

11 WHISTLE RDG
CANDLER NC
28715-9347
US

V. Phone/Fax

Practice location:
  • Phone: 828-367-7121
  • Fax:
Mailing address:
  • Phone: 917-470-5595
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number19797
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: