Provider Demographics
NPI:1417976903
Name:COLLINS, LUCKY LEE (LCSW, BCD)
Entity Type:Individual
Prefix:MS
First Name:LUCKY
Middle Name:LEE
Last Name:COLLINS
Suffix:
Gender:F
Credentials:LCSW, BCD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:416 S 4TH ST
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40422-2085
Mailing Address - Country:US
Mailing Address - Phone:859-236-0853
Mailing Address - Fax:859-236-0854
Practice Address - Street 1:416 S 4TH ST
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:KY
Practice Address - Zip Code:40422-2085
Practice Address - Country:US
Practice Address - Phone:859-236-0853
Practice Address - Fax:859-236-0854
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY751041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical