Healthcare Provider Details

I. General information

NPI: 1063486447
Provider Name (Legal Business Name): KATHLEEN S LEVENSTON L.C.S.W.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: KATHLEEN M. SHINE L.C.S.W.

II. Dates (important events)

Enumeration Date: 02/14/2006
Last Update Date: 03/03/2022
Certification Date: 03/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5001 W VILLAGE GREEN DR STE 205
MIDLOTHIAN VA
23112-4801
US

IV. Provider business mailing address

101 N LYNNHAVEN RD STE 100
VIRGINIA BEACH VA
23452-7523
US

V. Phone/Fax

Practice location:
  • Phone: 833-510-4357
  • Fax:
Mailing address:
  • Phone: 513-834-7063
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number0904005283
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number0904005283
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: