Provider Demographics
NPI:1093189078
Name:LUCAS, AFTON (MFT)
Entity Type:Individual
Prefix:
First Name:AFTON
Middle Name:
Last Name:LUCAS
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:AFTON
Other - Middle Name:
Other - Last Name:BLAKE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:1322 KILLARNEY AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90065-1812
Mailing Address - Country:US
Mailing Address - Phone:818-321-6404
Mailing Address - Fax:
Practice Address - Street 1:138 N BRAND BLVD STE 300
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91203-4618
Practice Address - Country:US
Practice Address - Phone:818-321-6404
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-13
Last Update Date:2015-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist