Provider Demographics
NPI:1861250854
Name:MEACHUM, LEVI E
Entity type:Individual
Prefix:
First Name:LEVI
Middle Name:E
Last Name:MEACHUM
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1102 MEMORIAL BLVD W
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:WV
Mailing Address - Zip Code:25701-4540
Mailing Address - Country:US
Mailing Address - Phone:304-840-5369
Mailing Address - Fax:
Practice Address - Street 1:1102 MEMORIAL BLVD W
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:WV
Practice Address - Zip Code:25701-4540
Practice Address - Country:US
Practice Address - Phone:304-840-5369
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-13
Last Update Date:2024-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVBP00946625104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker