Provider Demographics
NPI:1437207834
Name:LUCAS, TEINA (PSYD)
Entity Type:Individual
Prefix:
First Name:TEINA
Middle Name:
Last Name:LUCAS
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1650 LILIHA ST STE 101
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96817-3169
Mailing Address - Country:US
Mailing Address - Phone:808-234-8036
Mailing Address - Fax:808-538-0537
Practice Address - Street 1:1650 LILIHA ST STE 101
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96817-3169
Practice Address - Country:US
Practice Address - Phone:808-234-8036
Practice Address - Fax:808-538-0537
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-08
Last Update Date:2019-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIPSY-1762103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical