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General NPI Number Information
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NPI Number | 1710826664
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Entity Type | Organization
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Legal Business Name | AEVUM BH NC LLC
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Dates
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Enumeration Date | 03/26/2026
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Last Update Date | 03/26/2026
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Provider Practice Location Address
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Address Line | 635 STATESVILLE BLVD
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City | SALISBURY
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State | NC
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Zip | 28144-2201
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Country | US
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Telephone | 804-446-1710
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Fax |
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Provider Business Mailing Address
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Address Line | 175 ROUTE 70 STE 303
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City | TOMS RIVER
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State | NJ
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Zip | 08755-0936
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Country | US
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Telephone | 804-446-1710
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | LEVI LIPOVENKO
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Credential |
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Telephone | 804-446-1710
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number |
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License Number State |
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