Provider Demographics
NPI:1013416676
Name:SMITH, LUCILLE MARIE (LPCC)
Entity Type:Individual
Prefix:
First Name:LUCILLE
Middle Name:MARIE
Last Name:SMITH
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1093 ASHWOOD DR
Mailing Address - Street 2:
Mailing Address - City:MAYSVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:41056-9082
Mailing Address - Country:US
Mailing Address - Phone:606-584-2786
Mailing Address - Fax:
Practice Address - Street 1:217 COURT ST
Practice Address - Street 2:
Practice Address - City:MAYSVILLE
Practice Address - State:KY
Practice Address - Zip Code:41056-1105
Practice Address - Country:US
Practice Address - Phone:606-584-2786
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-08
Last Update Date:2018-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY173884101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional