Provider Demographics
NPI:1073026811
Name:LUCAS, WANDA C (LPCS)
Entity Type:Individual
Prefix:MS
First Name:WANDA
Middle Name:C
Last Name:LUCAS
Suffix:
Gender:F
Credentials:LPCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1293 PROFESSIONAL DR
Mailing Address - Street 2:SUITE D
Mailing Address - City:MYRTLE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29577
Mailing Address - Country:US
Mailing Address - Phone:843-902-1504
Mailing Address - Fax:843-939-9831
Practice Address - Street 1:1293 PROFESSIONAL DR STE D
Practice Address - Street 2:
Practice Address - City:MYRTLE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29577-5754
Practice Address - Country:US
Practice Address - Phone:843-902-1504
Practice Address - Fax:843-939-9831
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-15
Last Update Date:2017-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3602101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional