Provider Demographics
NPI:1346598174
Name:A. LUKE LUKENS LCSW CORPORATION
Entity Type:Organization
Organization Name:A. LUKE LUKENS LCSW CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL SOCIAL WORKER PRIVATE PRAC
Authorized Official - Prefix:MR
Authorized Official - First Name:ALLEN
Authorized Official - Middle Name:D
Authorized Official - Last Name:LUKENS
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:404-242-4772
Mailing Address - Street 1:750 LONGLEAF BLVD
Mailing Address - Street 2:SUITE C
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30046
Mailing Address - Country:US
Mailing Address - Phone:404-242-4772
Mailing Address - Fax:
Practice Address - Street 1:750 LONGLEAF BLVD
Practice Address - Street 2:SUITE C
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30046-8459
Practice Address - Country:US
Practice Address - Phone:404-242-4772
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-28
Last Update Date:2012-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW002534261QM0850X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health