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Organization

ETHAN R. LEVINE, PH.D.

Active
Organization subpart
No

Provider details

NPI number
Authorized official
DR. ETHAN ROY LEVINE PH.D. (MANAGING DIRECTOR)
(919) 264-3755
Entity
Organization

Contact information

Practice address
11937 STRAIGHT A WAY LN, RALEIGH, NC 27613-7105
(919) 264-3755
(919) 846-9231
Mailing address
11937 STRAIGHT A WAY LN, RALEIGH, NC 27613-7105
(919) 264-3755
(919) 846-9231

Taxonomy

Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
650
NC

Other

Enumeration date
02/05/2018
Last updated
02/05/2018
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