Provider Demographics
NPI:1346709359
Name:LUCAS, ELEANOR (CAODC)
Entity Type:Individual
Prefix:
First Name:ELEANOR
Middle Name:
Last Name:LUCAS
Suffix:
Gender:F
Credentials:CAODC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5132 VIA CALDERON
Mailing Address - Street 2:
Mailing Address - City:CAMARILLO
Mailing Address - State:CA
Mailing Address - Zip Code:93012-6737
Mailing Address - Country:US
Mailing Address - Phone:805-910-9993
Mailing Address - Fax:
Practice Address - Street 1:955 E THOMPSON BLVD
Practice Address - Street 2:
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93001-3008
Practice Address - Country:US
Practice Address - Phone:805-641-9100
Practice Address - Fax:805-641-9040
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-19
Last Update Date:2019-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA8228101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)