Provider Demographics
NPI:1609972140
Name:LUCERO-HAINES, CARMEN A (LPC, CAC II)
Entity Type:Individual
Prefix:
First Name:CARMEN
Middle Name:A
Last Name:LUCERO-HAINES
Suffix:
Gender:F
Credentials:LPC, CAC II
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1306 11TH AVE
Mailing Address - Street 2:
Mailing Address - City:GREELEY
Mailing Address - State:CO
Mailing Address - Zip Code:80631-3835
Mailing Address - Country:US
Mailing Address - Phone:970-347-2120
Mailing Address - Fax:970-353-3906
Practice Address - Street 1:597 OLD MOUNT HOLLY RD STE 300
Practice Address - Street 2:
Practice Address - City:GOOSE CREEK
Practice Address - State:SC
Practice Address - Zip Code:29445-2832
Practice Address - Country:US
Practice Address - Phone:843-501-1099
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-15
Last Update Date:2023-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO7032101YA0400X
CO5053101YP2500X
SC7807101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)