Provider Demographics
NPI:1013411933
Name:MCROBERTS, LUCAS MICHAEL (RADT)
Entity Type:Individual
Prefix:
First Name:LUCAS
Middle Name:MICHAEL
Last Name:MCROBERTS
Suffix:
Gender:M
Credentials:RADT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 437
Mailing Address - Street 2:
Mailing Address - City:COLOMA
Mailing Address - State:CA
Mailing Address - Zip Code:95613-0437
Mailing Address - Country:US
Mailing Address - Phone:530-626-7252
Mailing Address - Fax:530-626-7934
Practice Address - Street 1:838 BEACH CT
Practice Address - Street 2:
Practice Address - City:LOTUS
Practice Address - State:CA
Practice Address - Zip Code:95651-9565
Practice Address - Country:US
Practice Address - Phone:530-626-7252
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-23
Last Update Date:2018-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAR1281771117101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)