Provider Demographics
NPI:1407016728
Name:LUCIA, LORI LINDA (MFT)
Entity Type:Individual
Prefix:
First Name:LORI
Middle Name:LINDA
Last Name:LUCIA
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9770 ELMHURST DR
Mailing Address - Street 2:
Mailing Address - City:GRANITE BAY
Mailing Address - State:CA
Mailing Address - Zip Code:95746-7110
Mailing Address - Country:US
Mailing Address - Phone:916-671-4395
Mailing Address - Fax:916-791-6503
Practice Address - Street 1:8775 SIERRA COLLEGE BLVD
Practice Address - Street 2:SUITE 200
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95661-5985
Practice Address - Country:US
Practice Address - Phone:916-671-4395
Practice Address - Fax:916-791-6503
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-10
Last Update Date:2016-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA50090106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist