Provider Demographics
NPI:1598539942
Name:TOLBERT, LUCRETIA MICHELLE (MS ALC)
Entity Type:Individual
Prefix:
First Name:LUCRETIA
Middle Name:MICHELLE
Last Name:TOLBERT
Suffix:
Gender:F
Credentials:MS ALC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:153 SCOUTING CIR
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:AL
Mailing Address - Zip Code:36081-2540
Mailing Address - Country:US
Mailing Address - Phone:334-808-8991
Mailing Address - Fax:
Practice Address - Street 1:153 SCOUTING CIR
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:AL
Practice Address - Zip Code:36081-2540
Practice Address - Country:US
Practice Address - Phone:334-808-8991
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-07
Last Update Date:2024-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALALC03777101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health