Provider Demographics
NPI:1114468535
Name:LUCAS COUNSELING, PLLC
Entity Type:Organization
Organization Name:LUCAS COUNSELING, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL SOCIAL WORKER
Authorized Official - Prefix:
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:
Authorized Official - Last Name:SANGSTER-LUCAS
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:248-880-2964
Mailing Address - Street 1:301 MCCULLOUGH DR
Mailing Address - Street 2:SUITE 400
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28262-3310
Mailing Address - Country:US
Mailing Address - Phone:248-880-2964
Mailing Address - Fax:855-622-0417
Practice Address - Street 1:6030 BENNETTSVILLE LN
Practice Address - Street 2:APARTMENT 302
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28262-2387
Practice Address - Country:US
Practice Address - Phone:248-880-2964
Practice Address - Fax:855-622-0417
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-17
Last Update Date:2017-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0097281041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCC009728OtherLICENSE