Provider Demographics
NPI:1316571029
Name:ARTUKOVICH, LUCI ANN (CADC II, ICADC)
Entity Type:Individual
Prefix:
First Name:LUCI
Middle Name:ANN
Last Name:ARTUKOVICH
Suffix:
Gender:F
Credentials:CADC II, ICADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:410 N EUCLID AVE APT 7A
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91101-5318
Mailing Address - Country:US
Mailing Address - Phone:626-590-8587
Mailing Address - Fax:
Practice Address - Street 1:1230 N MARENGO AVE
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91103-2217
Practice Address - Country:US
Practice Address - Phone:626-797-1124
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-03
Last Update Date:2020-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA055301019101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty