Provider Demographics
NPI:1467085175
Name:LUCAS, EMILY LAURA I (CDCA)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:LAURA
Last Name:LUCAS
Suffix:I
Gender:F
Credentials:CDCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 368
Mailing Address - Street 2:
Mailing Address - City:BELMONT
Mailing Address - State:OH
Mailing Address - Zip Code:43718-0368
Mailing Address - Country:US
Mailing Address - Phone:740-484-4141
Mailing Address - Fax:740-484-4143
Practice Address - Street 1:56025 FLAT ROCK ROAD EXT
Practice Address - Street 2:
Practice Address - City:BARNESVILLE
Practice Address - State:OH
Practice Address - Zip Code:43713-9745
Practice Address - Country:US
Practice Address - Phone:740-238-1566
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-20
Last Update Date:2020-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
172750101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)