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General NPI Number Information
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NPI Number | 1538300025
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Entity Type | Individual
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Provider Name | ETHAN R LEVINE PH.D.
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Gender | Male
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Dates
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Enumeration Date | 03/13/2009
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Last Update Date | 04/08/2020
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Provider Practice Location Address
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Address Line | 101 CABARRUS AVE E
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City | CONCORD
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State | NC
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Zip | 28025-3699
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Country | US
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Telephone | 888-849-7379
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Fax | 855-857-7333
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Provider Business Mailing Address
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Address Line | 101 CABARRUS AVE E
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City | CONCORD
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State | NC
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Zip | 28025-3699
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Country | US
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Telephone | 888-849-7379
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Fax | 855-857-7333
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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 | 103T00000X
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Taxonomy Name | Psychologist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 650
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License Number State | NC
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Taxonomy #3
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Taxonomy Code | 103TC2200X
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Taxonomy Name | Clinical Child & Adolescent Psychologist
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License Number |
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Taxonomy #4
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Taxonomy Code | 103TE1100X
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Taxonomy Name | Exercise & Sports Psychologist
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Taxonomy #5
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Taxonomy Code | 103TH0100X
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Taxonomy Name | Health Service Psychologist
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Taxonomy #6
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Taxonomy Code | 103TR0400X
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Taxonomy Name | Rehabilitation Psychologist
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Taxonomy #7
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Taxonomy Code | 103TA0700X
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Taxonomy Name | Adult Development & Aging Psychologist
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License Number |
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License Number State |
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