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General NPI Number Information
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NPI Number | 1194050161
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Entity Type | Individual
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Provider Name | ANDREW LEVINE LPC
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Gender | Male
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Dates
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Enumeration Date | 10/08/2009
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Last Update Date | 11/19/2024
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Provider Practice Location Address
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Address Line | 16220 W MAIN ST
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City | LOUISVILLE
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State | MS
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Zip | 39339-2639
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Country | US
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Telephone | 662-773-9377
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Fax | 662-773-9025
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Provider Business Mailing Address
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Address Line | 302 N JACKSON ST
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City | STARKVILLE
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State | MS
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Zip | 39759-2504
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Country | US
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Telephone | 662-323-9261
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Fax | 662-324-9647
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 1491
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License Number State | MS
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