Provider Demographics
NPI:1225381668
Name:LU, GRACIE CHRISTINE (LCSW)
Entity Type:Individual
Prefix:MS
First Name:GRACIE
Middle Name:CHRISTINE
Last Name:LU
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 1:19742 MACARTHUR BLVD
Mailing Address - Street 2:STE. 135
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92612-2432
Mailing Address - Country:US
Mailing Address - Phone:949-505-9982
Mailing Address - Fax:
Practice Address - Street 1:19742 MACARTHUR BLVD
Practice Address - Street 2:STE. 135
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92612-2432
Practice Address - Country:US
Practice Address - Phone:949-505-9982
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-23
Last Update Date:2012-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS 277961041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical