Provider Demographics
NPI:1104345172
Name:LEVINE, AMY KRISTINE (LCPC)
Entity type:Individual
Prefix:MRS
First Name:AMY
Middle Name:KRISTINE
Last Name:LEVINE
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8215 E 1950TH AVE
Mailing Address - Street 2:
Mailing Address - City:JEWETT
Mailing Address - State:IL
Mailing Address - Zip Code:62436-2047
Mailing Address - Country:US
Mailing Address - Phone:217-821-6405
Mailing Address - Fax:
Practice Address - Street 1:213 W FAYETTE AVE
Practice Address - Street 2:
Practice Address - City:EFFINGHAM
Practice Address - State:IL
Practice Address - Zip Code:62401-2405
Practice Address - Country:US
Practice Address - Phone:618-387-1114
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-11
Last Update Date:2017-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180002816101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional