Provider Demographics
NPI:1992821029
Name:STOCKDALE, LEVESTER WAYNE (LCSW)
Entity type:Individual
Prefix:MR
First Name:LEVESTER
Middle Name:WAYNE
Last Name:STOCKDALE
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3762 CHIMNEY CREEK DR
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23462-6821
Mailing Address - Country:US
Mailing Address - Phone:757-498-3557
Mailing Address - Fax:757-616-0738
Practice Address - Street 1:850 TIDEWATER DR
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23504-3300
Practice Address - Country:US
Practice Address - Phone:757-616-0736
Practice Address - Fax:757-616-0738
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040020291041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical