Provider Demographics
NPI:1093957052
Name:LUCZKA, JANELLE ELIZABETH (LCSW)
Entity Type:Individual
Prefix:
First Name:JANELLE
Middle Name:ELIZABETH
Last Name:LUCZKA
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:915 INTERSTATE RIDGE DR
Mailing Address - Street 2:SUITE G
Mailing Address - City:GAINESVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30501-7076
Mailing Address - Country:US
Mailing Address - Phone:678-207-2900
Mailing Address - Fax:678-207-2904
Practice Address - Street 1:4331 THURMOND TANNER PKWY
Practice Address - Street 2:
Practice Address - City:FLOWERY BRANCH
Practice Address - State:GA
Practice Address - Zip Code:30542
Practice Address - Country:US
Practice Address - Phone:678-513-5700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-04-06
Last Update Date:2011-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW0044261041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical