Provider Demographics
NPI:1346492584
Name:LUCKRAFT, ELIZABETH (LCPC-C)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:LUCKRAFT
Suffix:
Gender:F
Credentials:LCPC-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:920 E POND RD
Mailing Address - Street 2:
Mailing Address - City:SMITHFIELD
Mailing Address - State:ME
Mailing Address - Zip Code:04978-3219
Mailing Address - Country:US
Mailing Address - Phone:207-692-4590
Mailing Address - Fax:207-634-5142
Practice Address - Street 1:316 WATER ST
Practice Address - Street 2:
Practice Address - City:SKOWHEGAN
Practice Address - State:ME
Practice Address - Zip Code:04976-1734
Practice Address - Country:US
Practice Address - Phone:207-692-4590
Practice Address - Fax:207-634-5142
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-21
Last Update Date:2010-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEXL3456101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor