Provider Demographics
NPI:1114787058
Name:LUKE, LAKELYN JUNE (RBT)
Entity Type:Individual
Prefix:
First Name:LAKELYN
Middle Name:JUNE
Last Name:LUKE
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 CARROLLTON DR
Mailing Address - Street 2:
Mailing Address - City:BRUNSWICK
Mailing Address - State:GA
Mailing Address - Zip Code:31525-5668
Mailing Address - Country:US
Mailing Address - Phone:912-617-7226
Mailing Address - Fax:
Practice Address - Street 1:10164 FORD AVE
Practice Address - Street 2:
Practice Address - City:RICHMOND HILL
Practice Address - State:GA
Practice Address - Zip Code:31324-3949
Practice Address - Country:US
Practice Address - Phone:912-459-9999
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-19
Last Update Date:2024-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician