Provider Demographics
NPI:1194378364
Name:LUCAS, CANDACE (BS)
Entity Type:Individual
Prefix:
First Name:CANDACE
Middle Name:
Last Name:LUCAS
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:477 VILLAGE SQUARE CT
Mailing Address - Street 2:
Mailing Address - City:STONE MOUNTAIN
Mailing Address - State:GA
Mailing Address - Zip Code:30083-4274
Mailing Address - Country:US
Mailing Address - Phone:251-554-1092
Mailing Address - Fax:
Practice Address - Street 1:477 VILLAGE SQUARE CT
Practice Address - Street 2:
Practice Address - City:STONE MOUNTAIN
Practice Address - State:GA
Practice Address - Zip Code:30083-4274
Practice Address - Country:US
Practice Address - Phone:251-554-1092
Practice Address - Fax:404-465-3650
Is Sole Proprietor?:No
Enumeration Date:2019-07-17
Last Update Date:2019-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
No225800000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRecreation Therapist