Provider Demographics
NPI:1417723156
Name:LUTYK, NORA CLARKE
Entity Type:Individual
Prefix:
First Name:NORA
Middle Name:CLARKE
Last Name:LUTYK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:106 SUNSET CT
Mailing Address - Street 2:
Mailing Address - City:LOCUST GROVE
Mailing Address - State:VA
Mailing Address - Zip Code:22508-5230
Mailing Address - Country:US
Mailing Address - Phone:703-851-7099
Mailing Address - Fax:
Practice Address - Street 1:106 SUNSET CT
Practice Address - Street 2:
Practice Address - City:LOCUST GROVE
Practice Address - State:VA
Practice Address - Zip Code:22508-5230
Practice Address - Country:US
Practice Address - Phone:703-851-7099
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-04
Last Update Date:2023-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701012809101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional