Provider Demographics
NPI:1609693589
Name:LEVINES, MONIC
Entity type:Individual
Prefix:
First Name:MONIC
Middle Name:
Last Name:LEVINES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MONIC
Other - Middle Name:
Other - Last Name:MARQUEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4434 COLUMBIA RD STE 105
Mailing Address - Street 2:
Mailing Address - City:MARTINEZ
Mailing Address - State:GA
Mailing Address - Zip Code:30907-4563
Mailing Address - Country:US
Mailing Address - Phone:706-955-7687
Mailing Address - Fax:706-535-3596
Practice Address - Street 1:4434 COLUMBIA RD STE 105
Practice Address - Street 2:
Practice Address - City:MARTINEZ
Practice Address - State:GA
Practice Address - Zip Code:30907-4563
Practice Address - Country:US
Practice Address - Phone:706-955-7687
Practice Address - Fax:706-535-3596
Is Sole Proprietor?:No
Enumeration Date:2024-09-23
Last Update Date:2024-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician